Researchers sought to analyze the long-term impact of transcatheter aortic valve replacement (TAVR) on coronary arteries and cardiac hemodynamics. Their results will be presented at TCT 2023 and were published in the Journal of the American College of Cardiology.
A significant proportion of TAVR candidates also present with coronary artery disease. Previous studies have focused primarily on short-term effects, and “the long-term impact of TAVR on coronary arteries and the hemodynamic changes within the circulatory system resulting from TAVR are still not fully understood,” the researchers noted.
They designed a multiscale, patient-specific, computational framework, which they based on and validated using clinically measured hemodynamics data. The model was tailored to individual patients, allowing the researchers to simulate and analyze the impact of TAVR on the cardiovascular system.
The findings from a sample size of 31 patients showed potentially adverse effects of TAVR on coronary hemodynamics, most notably insufficient coronary blood flow during the diastole phase. This lack of blood flow resulted in a reduction of the maximum coronary flow rate by 8.9% (P=.084), 16.8% (P<.05), and 22.7% (P=.059) in the left anterior descending artery, left circumflex coronary artery, and right coronary artery, respectively.
“The relief of transvalvular pressure gradient achieved through TAVR does not necessarily result in improved coronary flow or reduced cardiac load,” the researchers concluded. “Personalized, noninvasive, computational modeling could be helpful for determining the optimal revascularization strategy prior to TAVR and for assessing the progression of coronary artery disease following TAVR.”
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