TAVR is increasingly used to treat severe aortic stenosis (AS) patients. However, little is known regarding the direct effect of TAVR on the ventricular-aortic interaction. In the present study, we aimed to investigate changes in central hemodynamics after successful transcatheter aortic valve replacement (TAVR). We retrospectively examined 33 cases of severe AS patients (84±6 years) who underwent TAVR. Invasive measurements of left ventricular and aortic pressures as well as echocardiographic aortic flow were acquired before and after TAVR (maximum within 5 days). We examined alterations in key features of central pressure and flow waveforms, including the aortic augmentation index (AIx), and performed wave separation analysis. Arterial parameters were determined via parameter-fitting on a 2-element Windkessel model. Resolution of AS resulted in direct increase in the aortic systolic pressure and maximal aortic flow (131±22 mmHg versus 157±25 mmHg and 237±49 ml/sec versus 302±69 mL/sec, p<0.001 for all), while the ejection duration decreased (p<0.001). We noted a significant decrease in the AIx (from 42±12% to 19±11%, p<0.001). Noteworthy, the arterial properties remained unchanged. There was a comparable increase in both forward (61±20 mmHg versus 77±20 mmHg, p<0.001) and backward (35±14 mmHg versus 42±10 mmHg, p=0.013) pressure wave amplitudes, while their ratio, i.e., the reflection coefficient, was preserved. Our results highlight the impact of TAVR on the ventricular-aortic interaction by affecting the amplitude, shape and related attributes of the aortic pressure and flow pulse and challenge the interpretation of AIx as a solely vascular measure in AS patients.

中文翻译：

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经导管主动脉瓣置换对心室-主动脉相互作用的急性影响

TAVR越来越多地用于治疗严重的主动脉瓣狭窄（AS）患者。然而，关于TAVR对心室-主动脉相互作用的直接影响知之甚少。在本研究中，我们旨在研究成功经导管主动脉瓣置换术（TAVR）后中心血液动力学的变化。我们回顾性分析了33例接受TAVR的严重AS患者（84±6岁）。在TAVR之前和之后（5天内最大）采集左心室和主动脉压的浸润测量值以及超声心动图主动脉血流。我们检查了中心压力和流量波形的关键特征的变化，包括主动脉增大指数（AIx），并进行了波分离分析。动脉参数是通过在2元素Windkessel模型上进行参数拟合确定的。AS的消退导致主动脉收缩压和主动脉最大流量的直接增加（131±22 mmHg对157±25 mmHg和237±49 ml / sec对302±69 mL / sec，所有p <0.001），而射血持续时间减少（p <0.001）。我们注意到AIx显着降低（从42±12％降至19±11％，p <0.001）。值得注意的是，动脉性质保持不变。向前（61±20 mmHg对77±20 mmHg，p <0.001）和向后（35±14 mmHg对42±10 mmHg，p = 0.013）压力波幅度都有相当的增加，而它们的比率即反射系数得以保留。我们的结果通过影响振幅来突出TAVR对心室-主动脉相互作用的影响，