Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement.
Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement.
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DOI：
10.1007/s10554-015-0792-x
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发表时间：
2016-03
期刊：
影响因子：
--
通讯作者：
von Knobelsdorff-Brenkenhoff F
中科院分区：
文献类型：
--
作者：
Trauzeddel RF;Löbe U;Barker AJ;Gelsinger C;Butter C;Markl M;Schulz-Menger J;von Knobelsdorff-Brenkenhoff F
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 MR (spatial / temporal resolution 2.1×2.4×2.2mm3 / 38.4ms) of the ascending aorta. Target parameters were: severity of vortices and helices (semiquantitative grading from 0=none to 3=severe) and the local distribution of systolic wall shear stress (WSSsystole). AVR revealed significantly more extensive vortices and helices than TAVI (p=0.042 and p=0.002) and controls (p<0.001 and p=0.001). TAVI showed significantly more extensive vortices 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 vertical blood flow.
