Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement
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Published:2023-10-26
Issue:1
Volume:25
Page:
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ISSN:1532-429X
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Container-title:Journal of Cardiovascular Magnetic Resonance
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language:en
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Short-container-title:J Cardiovasc Magn Reson
Author:
Takahashi Yuki, Kamiya Kiwamu, Nagai ToshiyukiORCID, Tsuneta Satonori, Oyama-Manabe Noriko, Hamaya Takeshi, Kazui Sho, Yasui Yutaro, Saiin Kohei, Naito Seiichiro, Mizuguchi Yoshifumi, Takenaka Sakae, Tada Atsushi, Ishizaka Suguru, Kobayashi Yuta, Omote Kazunori, Sato Takuma, Shingu Yasushige, Kudo Kohsuke, Wakasa Satoru, Anzai Toshihisa
Abstract
Abstract
Background
The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR).
Methods
We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients’ refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4–39] days) and after (median interval, 6 [IQR 3–6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR.
Results
The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: − 0.22 ± 0.86 vs. SEV: − 0.85 ± 0.80, P < 0.001 and BEV: − 0.11 ± 0.79 vs. SEV: − 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: − 0.6 [− 2.1 to 0.5] Pa vs. SEV: − 1.8 [− 3.5 to − 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups.
Conclusions
Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.
Funder
Japan Society for the Promotion of Science Takeda Science Foundation Japan Cardiovascular Research Foundation
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,Radiological and Ultrasound Technology
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