Introduction
Pressure recovery (PR) in aortic stenosis (AS) occurrence has been studied since the
late 1980’s as specific cases applicable only to small or low-normal ranges aortas.
[1] Interest regarding PR has increased significantly in recent years. [2-3] The aim
of our study is to determine the impact of PR adjustment on disease severity in patients
with severe AS by traditional grading methods. We hypothesize that accounting for
PR will result in a reclassification of aortic stenosis severity in a significant
number of patients.
Methods
After institutional board approval, we performed a retrospective single center study
on patients who underwent TAVR at Tufts Medical center between October 2012 to February
2021. Standard measurements and mean transaortic gradients were obtained by pre-procedure
transthoracic echocardiograms. Aortic valve areas (AVA) were calculated using the
continuity equation. PR and PR adjusted AVA were calculated using previously validated
equations. [4-5] Sinotubular junction (STJ) size was obtained from pre-procedural
computerized tomography (CT) scans.
Results
Patient characteristics are shown in Table 1. A total of 544 patients were evaluated
after excluding patients greater than mild mitral or aortic regurgitation. The absolute
value of pressure PR recovery was significantly different between the reclassified
groups. (p-value = 0.02) Using PR adjusted AVA resulted in the reclassification of
109 patients (25.05%) from severe to moderate aortic stenosis (AVA >1 cm2). Of the
109 patients who were reclassified, 36 patients (33.02%) had STJ diameters >3.0 cm.
(Table 1)
Discussion
Adjusting calculated AVA for PR resulted in a reclassification of a significant number
of adult patients from severe to moderate aortic stenosis. PR was significantly larger
in patients who reclassified from severe to moderate aortic stenosis after adjusting
for PR. There was no difference in STJ diameter between the PR adjusted groups. Our
data suggests that those patients most vulnerable to reclassification with PR adjustment
are those with the largest calculated “severe” aortic valve areas, rather than those
with particular aortic root dimensions.
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Identification
Copyright
© 2021 Published by Elsevier Inc.
