Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation

Objectives We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). Backgrounds LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2018-10, Vol.92 (4), p.E288-E298
Main Authors: Tsuruta, Hikaru, Hayashida, Kentaro, Yashima, Fumiaki, Yanagisawa, Ryo, Tanaka, Makoto, Arai, Takahide, Minakata, Yugo, Itabashi, Yuji, Murata, Mitsushige, Kohsaka, Shun, Maekawa, Yuichiro, Takahashi, Tatsuo, Yoshitake, Akihiro, Shimizu, Hideyuki, Fukuda, Keiichi
Format: Article
Language:English
Subjects:
Aortic stenosis
Aortic valve
aortic valve stenosis
Clinical outcomes
echocardiography
Heart diseases
Implantation
Incidence
Mercury
Multivariate analysis
Peak pressure
Stenosis
transcatheter aortic valve replacement
Ventricle
ventricular outflow obstruction
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Summary:Objectives We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). Backgrounds LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. Methods A total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI. LVO was defined as a peak pressure gradient >30 mm Hg. Results Over 1 year of follow‐up after TAVI, 21 patients (13.3%) demonstrated postprocedural LVO. The incidence was highest at 3‐months follow‐up and decreased at 6 months or later. Of the 21 patients with LVO, 20 (95.2%) demonstrated midventricular obstruction (MVO), whereas only 1 (4.8%) showed obstruction of the outflow tract (LVOT) with systolic anterior motion (SAM) of the mitral leaflet. In a multivariate analysis, the LVOT diameter (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.30–0.67; P 
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.27508