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Peri-Procedural, Non-Invasive Hemodynamic Monitoring In TAVI-Patients: Potential Impact on Patient Selection and Outcome Prediction

Markus B, Karatolios K, Wulle C, Pethig D, Rastan A, Schieffer B and Divchev D

Objectives and Background: To investigate short-term hemodynamic improvement following transcatheter aortic valve implantation (TAVI) in patients with severe aortic valve stenosis (AS) using the non-invasive NICaS® whole body electrical bio-impedance monitoring system.

Methods: 52 unselected patients subjected to TAVI were analysed between January and September 2018. Endovascular TAVI was applied in local anaesthesia and analgosedation in all patients using the Medtronic Evolut R® (n=32), Edwards Sapien 3® (n=14) or Boston Scientific SYMETIS ACURATE neo ™ TF® (n=4) system. NICaS® measurements were performed at baseline, six to eight hours after TAVI procedure and before discharge.

Results and Discussion: When comparing discharge to baseline, there was a successful increase in cardiac output (CO) from 5.01 ± 1.62 to 5.73 ± 1.41 L/min (P=0.009) corresponding to a cardiac index (CI) increase from 2.64 ± 0.80 to 3.13 ± 0.83 L/min/m2 (P=0.002) and of increase in cardiac power index (CPI) from 0.53 ± 0.18 to 0.61 ± 0.16 w/m2 (P=0.008). Additionally, total peripheral resistance (TPR) significantly decrease from 1597.58 ± 624.92 to 1291.29 ± 450.12 dynes*s/cm5 (P=0.0045) corresponding to a total peripheral resistance index (TPRI) decrease from 2968.88 ± 1078.78 to 2436.72 ± 902.37 dynes*s/cm5/m2 (P=0.006).

Conclusion: Non-invasive hemodynamic measurements with NICaS® represent an accurate bedside-tool for monitoring short-term adaptive hemodynamic changes in unselected patients subjected to TAVI. Thus, results can be easily used for tailored peri-procedural management early patients´ mobilization and discharge planning.