Comparison of cardiac energetics after transcatheter and surgical aortic valve replacements

研究成果: ジャーナルへの寄稿記事

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OBJECTIVES: The effect of transcatheter aortic valve replacement (TAVR) on cardiac energetics has not been described. We compared changes in cardiac energetics after TAVR with those after surgical aortic valve replacement (SAVR). METHODS: We retrospectively estimated end-systolic elastance (Ees) and effective arterial elastance (Ea) using blood pressure and left ventricular (LV) volume obtained from echocardiography. LV efficiency [ventriculoarterial coupling (Ea/Ees) and the stroke work to pressure-volume area ratio (SW/PVA)] was calculated. Measurements were taken before, 1 week after and 1 year after bioprosthetic aortic valve replacement (TAVR, n = 56; SAVR, n = 61) in patients with severe aortic stenosis and preserved ejection fraction. RESULTS: Patients with TAVR had a lower aortic valve pressure gradient and larger stroke volume 1 week after the procedure than those with SAVR. Ea was more markedly decreased, and LV efficiency was significantly improved 1 week after TAVR (SW/PVA 68.1% ± 8.4% to 72.0% ± 8.5%, P < 0.001), but LV efficiency was unchanged 1 week after SAVR (SW/PVA 70.1% ± 7.4% to 69.1% ± 8.0%). LV efficiency was improved 1 year after both procedures (SW/PVA 75.5% ± 6.1% in TAVR; 74.7% ± 6.4% in SAVR). CONCLUSIONS: TAVR decreases the transvalvular pressure gradient further without deteriorating stroke volume in the early postoperative period, which is accompanied by early improvement in afterload and LV efficiency compared with SAVR. Improvement in LV efficiency at mid-term follow-up is satisfactory after both procedures.

元の言語英語
ページ(範囲)587-593
ページ数7
ジャーナルInteractive cardiovascular and thoracic surgery
28
発行部数4
DOI
出版物ステータス出版済み - 1 1 2019

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Aortic Valve
Surgical Instruments
Pressure
Stroke
Stroke Volume
Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis
Postoperative Period
Echocardiography
Arterial Pressure
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

これを引用

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title = "Comparison of cardiac energetics after transcatheter and surgical aortic valve replacements",
abstract = "OBJECTIVES: The effect of transcatheter aortic valve replacement (TAVR) on cardiac energetics has not been described. We compared changes in cardiac energetics after TAVR with those after surgical aortic valve replacement (SAVR). METHODS: We retrospectively estimated end-systolic elastance (Ees) and effective arterial elastance (Ea) using blood pressure and left ventricular (LV) volume obtained from echocardiography. LV efficiency [ventriculoarterial coupling (Ea/Ees) and the stroke work to pressure-volume area ratio (SW/PVA)] was calculated. Measurements were taken before, 1 week after and 1 year after bioprosthetic aortic valve replacement (TAVR, n = 56; SAVR, n = 61) in patients with severe aortic stenosis and preserved ejection fraction. RESULTS: Patients with TAVR had a lower aortic valve pressure gradient and larger stroke volume 1 week after the procedure than those with SAVR. Ea was more markedly decreased, and LV efficiency was significantly improved 1 week after TAVR (SW/PVA 68.1{\%} ± 8.4{\%} to 72.0{\%} ± 8.5{\%}, P < 0.001), but LV efficiency was unchanged 1 week after SAVR (SW/PVA 70.1{\%} ± 7.4{\%} to 69.1{\%} ± 8.0{\%}). LV efficiency was improved 1 year after both procedures (SW/PVA 75.5{\%} ± 6.1{\%} in TAVR; 74.7{\%} ± 6.4{\%} in SAVR). CONCLUSIONS: TAVR decreases the transvalvular pressure gradient further without deteriorating stroke volume in the early postoperative period, which is accompanied by early improvement in afterload and LV efficiency compared with SAVR. Improvement in LV efficiency at mid-term follow-up is satisfactory after both procedures.",
author = "Yoshiyuki Yamashita and Yoshihisa Tanoue and Hiromichi Sonoda and Tomoki Ushijima and Satoshi Kimura and Yasuhisa Oishi and Hideki Tatewaki and Hiasa Ken-Ichi and Takeshi Arita and Akira Shiose",
year = "2019",
month = "1",
day = "1",
doi = "10.1093/icvts/ivy292",
language = "English",
volume = "28",
pages = "587--593",
journal = "Interactive Cardiovascular and Thoracic Surgery",
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T1 - Comparison of cardiac energetics after transcatheter and surgical aortic valve replacements

AU - Yamashita, Yoshiyuki

AU - Tanoue, Yoshihisa

AU - Sonoda, Hiromichi

AU - Ushijima, Tomoki

AU - Kimura, Satoshi

AU - Oishi, Yasuhisa

AU - Tatewaki, Hideki

AU - Ken-Ichi, Hiasa

AU - Arita, Takeshi

AU - Shiose, Akira

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVES: The effect of transcatheter aortic valve replacement (TAVR) on cardiac energetics has not been described. We compared changes in cardiac energetics after TAVR with those after surgical aortic valve replacement (SAVR). METHODS: We retrospectively estimated end-systolic elastance (Ees) and effective arterial elastance (Ea) using blood pressure and left ventricular (LV) volume obtained from echocardiography. LV efficiency [ventriculoarterial coupling (Ea/Ees) and the stroke work to pressure-volume area ratio (SW/PVA)] was calculated. Measurements were taken before, 1 week after and 1 year after bioprosthetic aortic valve replacement (TAVR, n = 56; SAVR, n = 61) in patients with severe aortic stenosis and preserved ejection fraction. RESULTS: Patients with TAVR had a lower aortic valve pressure gradient and larger stroke volume 1 week after the procedure than those with SAVR. Ea was more markedly decreased, and LV efficiency was significantly improved 1 week after TAVR (SW/PVA 68.1% ± 8.4% to 72.0% ± 8.5%, P < 0.001), but LV efficiency was unchanged 1 week after SAVR (SW/PVA 70.1% ± 7.4% to 69.1% ± 8.0%). LV efficiency was improved 1 year after both procedures (SW/PVA 75.5% ± 6.1% in TAVR; 74.7% ± 6.4% in SAVR). CONCLUSIONS: TAVR decreases the transvalvular pressure gradient further without deteriorating stroke volume in the early postoperative period, which is accompanied by early improvement in afterload and LV efficiency compared with SAVR. Improvement in LV efficiency at mid-term follow-up is satisfactory after both procedures.

AB - OBJECTIVES: The effect of transcatheter aortic valve replacement (TAVR) on cardiac energetics has not been described. We compared changes in cardiac energetics after TAVR with those after surgical aortic valve replacement (SAVR). METHODS: We retrospectively estimated end-systolic elastance (Ees) and effective arterial elastance (Ea) using blood pressure and left ventricular (LV) volume obtained from echocardiography. LV efficiency [ventriculoarterial coupling (Ea/Ees) and the stroke work to pressure-volume area ratio (SW/PVA)] was calculated. Measurements were taken before, 1 week after and 1 year after bioprosthetic aortic valve replacement (TAVR, n = 56; SAVR, n = 61) in patients with severe aortic stenosis and preserved ejection fraction. RESULTS: Patients with TAVR had a lower aortic valve pressure gradient and larger stroke volume 1 week after the procedure than those with SAVR. Ea was more markedly decreased, and LV efficiency was significantly improved 1 week after TAVR (SW/PVA 68.1% ± 8.4% to 72.0% ± 8.5%, P < 0.001), but LV efficiency was unchanged 1 week after SAVR (SW/PVA 70.1% ± 7.4% to 69.1% ± 8.0%). LV efficiency was improved 1 year after both procedures (SW/PVA 75.5% ± 6.1% in TAVR; 74.7% ± 6.4% in SAVR). CONCLUSIONS: TAVR decreases the transvalvular pressure gradient further without deteriorating stroke volume in the early postoperative period, which is accompanied by early improvement in afterload and LV efficiency compared with SAVR. Improvement in LV efficiency at mid-term follow-up is satisfactory after both procedures.

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U2 - 10.1093/icvts/ivy292

DO - 10.1093/icvts/ivy292

M3 - Article

VL - 28

SP - 587

EP - 593

JO - Interactive Cardiovascular and Thoracic Surgery

JF - Interactive Cardiovascular and Thoracic Surgery

SN - 1569-9293

IS - 4

ER -