Transcatheter Aortic Valve Implantation and Intraoperative Left Ventricular Function: A Myocardial Tissue Doppler Imaging Study

Objective Transcatheter aortic valve implantation in patients turned down for surgical aortic valve replacement is a high-risk procedure. Severe aortic stenosis is associated with impaired left ventricular longitudinal motion, and myocardial peak systolic velocity is a measure of left ventricular function in these patients. The present study aimed to quantify the acute changes in left ventricular function during the procedure by using myocardial tissue Doppler imaging and transthoracic cardiac output measurements. Design Prospective observational study. Setting Tertiary care university hospital. Participants 40 patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation. Interventions Transesophageal 4-chamber and 2-chamber echocardiograms were performed immediately before and ~15 minutes after valve implantation. Longitudinal myocardial peak systolic velocity was obtained by tissue Doppler imaging from 8 basal segments and averaged. Cardiac output was measured by the lithium dilution method, and systemic vascular resistance index and stroke volume were calculated. Measurements and Main Results Longitudinal myocardial peak systolic velocity improved immediately after valve implantation, from –2.3±0.8 to –3.0±1.1 cm/sec (p