title: Effect of transcatheter aortic valve implantation on intraoperative left ventricular end-diastolic pressure.
abstract: Transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis is a less invasive alternative to surgical aortic valve replacement. Despite this, careful anesthetic management, especially strict control of blood pressure and fluid management, is necessary. During TAVI, normalization of left ventricular afterload due to aortic balloon valvuloplasty and prosthetic valve deployment is expected to result in rapid improvement of systolic function and consequent improvement in diastolic function. However, the early effect of TAVI on left ventricular diastolic function is less clear. We hypothesized that TAVI induces a rapid decrease in left ventricular end-diastolic pressure (LVEDP) after valve deployment. This retrospective observational study included 71 patients who had undergone TAVI using the transfemoral approach with a balloon-expandable valve under general anesthesia. Intraoperative LVEDP was measured using an intracardiac catheter. The severity of residual aortic regurgitation (AR) was assessed using the Sellers criteria. The mean (SD) LVEDP was 17.8 (5.3) mmHg just before TAVI and increased significantly to 27.3 (8.2) mmHg immediately after prosthetic valve deployment (p < 0.0001). The change in LVEDP was 8.7 (8.6) mmHg in patients with low residual AR (Sellers ≤1) and 11.0 (7.1) mmHg in those with high residual AR (Sellers ≥2); however, this difference was not significant. No correlation was found between the LVEDP change and intraoperative fluid balance. In conclusion, LVEDP increased significantly in the early period after valve deployment during TAVI, regardless of residual AR severity. It was suggested that the tolerability of fluid load could be reduced at that time.
authors: Department of Anaesthesia, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura City, Kanagawa Prefecture, 247-8533, Japan. toyvox1@me.com.
authors: Kosaku
authors: 0000-0003-0545-969X
authors: K
authors: Toyota
authors: Department of Anaesthesia, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura City, Kanagawa Prefecture, 247-8533, Japan.
authors: Takashi
authors: T
authors: Ota
authors: Department of Anaesthesia, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura City, Kanagawa Prefecture, 247-8533, Japan.
authors: Katsutoshi
authors: K
authors: Nagamine
authors: Department of Anaesthesia, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura City, Kanagawa Prefecture, 247-8533, Japan.
authors: Yasuhiro
authors: Y
authors: Koide
authors: Department of Anaesthesiology, Yokohama City University, Yokohama, Japan.
authors: Takeshi
authors: T
authors: Nomura
authors: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.
authors: Futoshi
authors: F
authors: Yamanaka
authors: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.
authors: Koki
authors: K
authors: Shishido
authors: Department of Cardiac Surgery, Nihon University Itabashi Hospital, Tokyo, Japan.
authors: Masashi
authors: M
authors: Tanaka
authors: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.
authors: Shigeru
authors: S
authors: Saito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016277:Ventricular Function, Left
keywords: Aortic regurgitation; LV filling physiology; Left ventricular end-diastolic pressure; TAVI complications