Association of a Novel Hemodynamic Index with Aortic Regurgitation after Transcatheter Aortic Valve Regurgitation with the Edwards Sapien Valve.

Narayanswami, Jyoti

Association of a Novel Hemodynamic Index with Aortic Regurgitation after Transcatheter Aortic Valve Regurgitation with the Edwards Sapien Valve.

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Divyanshu Mohananey , Medical College Of Wisconsin, Wauwatosa, WI

Jyoti Narayanswami , Case Western Reserve University School of Medicine, Cleveland, OH

Arnav Kumar, MD, MSCR , Emory University School of Medicine, Atlanta, GA

Yasser M Sammour, MD , Cleveland Clinic Foundation

Stephanie L Mick, MD , Cleveland Clinic Foundation, Cleveland, OH

Jose L Navia, MD , Cleveland Clinic Foundation, Cleveland, OH

E. Murat Tuzcu, M.D., FSCAI , Cleveland Clinic, Cleveland, OH

Amar Krishnaswamy, M.D. , Cleveland Clinic, Cleveland, OH

Samir Ramesh Kapadia, M.D., FSCAI , Cleveland Clinic, Cleveland, OH

Background:
Paravalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) is a well-known complication. Post-TAVR AR is thought to be caused due to incomplete apposition of the prosthesis, suboptimal expansion of the stent frame, misplacement of the prosthesis or mismatch in the size of the annulus and the prosthesis. We aimed to study the use of a novel hemodynamic ratio which can be easily estimated by visual inspection of the aortic pressure tracings to identify patients with significant post-TAVR AR.

Methods:
In this study we included 204 patients undergoing TAVR with the Edward Sapien Valve at Cleveland Clinic Foundation between January 1 2014 and April 31^st 2016 who had analyzable hemodynamic aortic waveforms. The dicrotic notch index (DNI) was defined as the difference of systolic blood pressure and dicrotic notch divided by the pulse pressure. We defined hemodynamically significant AR as ≥ moderate in severity.

Results:
We observed a lower DNI in patients with hemodynamically significant AR [0.57 ± 0.05 vs. 0.66 ± 0.09, p=0.04]. On ROC analysis, we observed that this ratio has a good predictive value in detecting hemodynamically significant AR with an AUC of 0.8 (95% CI 0.69-0.91,p=0.021). Using a cut-off of <0.63 provides a 100% sensitivity whereas a cut-off of <0.50 provides a 95.5% specificity for detecting hemodynamically significant AR.

Conclusions:
In our study of 204 patients undergoing TAVR with Edwards Sapien Valve, we observed that a novel DNI performs well in identifying hemodynamically significant AR.