Aortic Valve Stenosis Clinical Trial
Official title:
Ventriculo-arterial Coupling Modification Evaluated by PRAM (Pressure Recording Analytical Method) in the Aortic Stenosis Treated by TAVI (Transcatheter Aortic Valve Implantation)
Calcified aortic stenosis is the most frequent valvulopathy in Europe and North America.
Aortic stenosis is an obstacle to the ejection of blood from the left ventricle to the aorta
and leads to morphological changes in the left ventricle and hemodynamic modifications.
Intrinsic ventricular performance can be characterized using three parameters:
- Ventricular elastance (Ees for End Systolic Elastance) which represents the index of
ventricular contractility independently of the load.
- Arterial elastance (Ea for Arterial Elastance) which represents the post-load
- The ventriculo-arterial coupling index (Ees / Ea) which represents energy efficiency.
For patients with high surgical risk (EuroSCORE II> 6), TAVI (Transcatheter Aortic Valve
Implantation) is recommended for aortic valve replacement. Many complications may occur after
TAVI (haemorrhagic, embolic, renal, myocardial ischemia). Post-TAVI complications may also be
cardiac decompensation of the underlying cardiac disease to cardiogenic shock. However,
literature on left ventricular performance after aortic valvular replacement is poor because
of the difficulty and invasiveness of the analysis involved.
Cardiac energy analysis plays an additional role in understanding the clinical patients
conditions. On this point, cardiac energy modifications, based on ventriculo-arterial
coupling, could be indicators of cardiac function. Two methods (ultrasound and pulse contour)
are used to understand and explore the ventriculo-arterial coupling, preload, postload,
contractility and hemodynamic changes interactions.
Echocardiography allows the Ees / Ea and SW / PVA (Stoke work/ pressure-volume area) ratios
mesurements. PRAM (Pressure Recording Analytical Method) through the MostCare® monitor, gives
common hemodynamic parameters and more specific parameters such as arterial elastance (Ea)
cardiac cycle efficiency (CCE), dP / dt. Cardiac cycle efficiency (CCE) is an exclusive
variable that describes the hemodynamic performance in terms of energy expenditure in the
patient being followed.
TAVI procedure is an acute model of ventriculo-arterial coupling modification by treatment of
the ventricular ejection obstacle. The PRAM method evaluates the ventriculo-arterial
coupling. The aim of our study is to evaluate by PRAM the changes in cardiac energy variables
before and after aortic valve replacement by TAVI
n/a
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