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

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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.

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Acknowledgments

We thank our technicians Kerstin Kretschel, Evelyn Polzin and Denise Kleindiest for performing the CMR scans. We also thank our study nurses Elke Nickel-Szczech and Annette Koehler as well as the other working group members for their assistance in realizing the study. This study was partly funded by the National Institutes of Health (NIH K25HL119608, R01HL115828).

Funding

This study was partly funded by the National Institutes of Health (NIH K25HL119608, R01HL115828).

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Authors and Affiliations

  1. Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Charité Medical University Berlin, Lindenberger Weg 80, 13125, Berlin, Germany

    Ralf Felix Trauzeddel, Jeanette Schulz-Menger & Florian von Knobelsdorff-Brenkenhoff

  2. Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany

    Ralf Felix Trauzeddel, Jeanette Schulz-Menger & Florian von Knobelsdorff-Brenkenhoff

  3. Department of Cardiology, Immanuel Klinikum Bernau, Heart Center Brandenburg, Bernau, Germany

    Ulrike Löbe, Carmen Gelsinger & Christian Butter

  4. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Alex J. Barker & Michael Markl

  5. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA

    Alex J. Barker & Michael Markl

Authors
  1. Ralf Felix Trauzeddel
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  2. Ulrike Löbe
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  3. Alex J. Barker
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  4. Carmen Gelsinger
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  5. Christian Butter
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  6. Michael Markl
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  7. Jeanette Schulz-Menger
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  8. Florian von Knobelsdorff-Brenkenhoff
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Correspondence to Florian von Knobelsdorff-Brenkenhoff.

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The authors declare that they have no conflict of interest.

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All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Trauzeddel, R.F., Löbe, U., Barker, A.J. et al. Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement. Int J Cardiovasc Imaging 32, 461–467 (2016). https://doi.org/10.1007/s10554-015-0792-x

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  • DOI: https://doi.org/10.1007/s10554-015-0792-x

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