Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement

Item Type:	Article
Title:	Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement
Creators Name:	Trauzeddel, R.F. and Löbe, U. and Barker, A.J. and Gelsinger, C. and Butter, C. and Markl, M. and Schulz-Menger, J. and von Knobelsdorff-Brenkenhoff, F.
Abstract:	Ascending aortic blood flow characteristics are altered after aortic valve surgery, but the effect of transcatheter aortic valve implantation (TAVI) is unknown. Abnormal flow may be associated with aortic and cardiac remodeling. We analyzed blood flow characteristics in the ascending aorta after TAVI in comparison to conventional stented aortic bioprostheses (AVR) and healthy subjects using time-resolved three-dimensional flow-sensitive cardiovascular magnetic resonance imaging (4D-flow MRI). Seventeen patients with TAVI (Edwards Sapien XT), 12 with AVR and 9 healthy controls underwent 4D-flow MRI of the ascending aorta. Target parameters were: severity of vortical and helical flow pattern (semiquantitative grading from 0 = none to 3 = severe) and the local distribution of systolic wall shear stress (WSSsystole). AVR revealed significantly more extensive vortical and helical flow pattern than TAVI (p = 0.042 and p = 0.002) and controls (p < 0.001 and p = 0.001). TAVI showed significantly more extensive vortical flow than controls (p < 0.001). Both TAVI and AVR revealed marked blood flow eccentricity (64.7 and 66.7 %, respectively), whereas controls showed central blood flow (88.9 %). TAVI and AVR exhibited an asymmetric distribution of WSSsystole in the mid-ascending aorta with local maxima at the right anterior aortic wall and local minima at the left posterior wall. In contrast, controls showed a symmetric distribution of WSSsystole along the aortic circumference. Blood flow was significantly altered in the ascending aorta after TAVI and AVR. Changes were similar regarding WSSsystole distribution, while TAVI resulted in less helical and vortical blood flow.
Keywords:	Magnetic Resonance Imaging, Aorta, Aortic Valve Replacement, Shear Stress, Transcatheter Aortic Valve Implantation, 4D-Flow
Source:	International Journal of Cardiovascular Imaging
ISSN:	1569-5794
Publisher:	Springer
Volume:	32
Number:	3
Page Range:	461-467
Date:	March 2016
Additional Information:	Copyright © Springer Science+Business Media Dordrecht 2015
Official Publication:	https://doi.org/10.1007/s10554-015-0792-x
External Fulltext:	View full text on PubMed Central
PubMed:	View item in PubMed

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