Differential Impact of Blood Pressure Control Targets on Epicardial Coronary Flow After Transcatheter Aortic Valve Replacement

Brennan J. Vogl, BS; Alejandra Chavez-Ponce, MD; Adam Wentworth, MS; Eric Erie, AAS; Pradeep Yadav, MD; Vinod H. Thourani, MD; Lakshmi Prasad Dasi, PhD; Brian Lindman, MD, MSc; Mohamad Alkhouli, MD; Hoda Hatoum, PhD

Structural Heart (Jan 2024)

Differential Impact of Blood Pressure Control Targets on Epicardial Coronary Flow After Transcatheter Aortic Valve Replacement

Brennan J. Vogl, BS,
Alejandra Chavez-Ponce, MD,
Adam Wentworth, MS,
Eric Erie, AAS,
Pradeep Yadav, MD,
Vinod H. Thourani, MD,
Lakshmi Prasad Dasi, PhD,
Brian Lindman, MD, MSc,
Mohamad Alkhouli, MD,
Hoda Hatoum, PhD

Affiliations

Brennan J. Vogl, BS: Biomedical Engineering Department, Michigan Technological University, Houghton, Michigan, USA
Alejandra Chavez-Ponce, MD: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Adam Wentworth, MS: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
Eric Erie, AAS: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
Pradeep Yadav, MD: Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
Vinod H. Thourani, MD: Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
Lakshmi Prasad Dasi, PhD: Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
Brian Lindman, MD, MSc: Division of Cardiovascular Medicine, Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Mohamad Alkhouli, MD: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Hoda Hatoum, PhD: Biomedical Engineering Department, Michigan Technological University, Houghton, Michigan, USA; Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybersystems, Michigan Technological University, Houghton, Michigan, USA; Address correspondence to: Hoda Hatoum, PhD, Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr, Houghton, MI 49931.

Journal volume & issue: Vol. 8, no. 1
p. 100230

Abstract

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Background: The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion. Methods: The hemodynamics of a 3D printed aortic root model with a SAPIEN 3 26 deployed were evaluated in an in vitro left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value 0.9 for SBP ≥130 mmHg. However, at an SBP of 120 mmHg, the flow ratio was 0.63 (p ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91. Conclusions: Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.

Published in Structural Heart

ISSN: 2474-8706 (Print); 2474-8714 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/structural-heart

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