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Impact of blood pressure on coronary perfusion and valvular hemodynamics after aortic valve replacement

Brennan J Vogl1, Yousef M Darestani2, Scott M Lilly3

  • 1Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 22, 2021
PubMed

Insights

Lowering blood pressure (BP) after aortic valve replacement (AVR) can reduce coronary flow (CF) below physiological limits, even within guideline targets. Further research is needed to determine optimal BP management post-AVR.

Area of Science:

  • Cardiovascular research
  • Medical device engineering
  • Hemodynamics

Background:

  • Lower systolic and diastolic blood pressures (SBP/DBP) post-aortic valve replacement (AVR) are linked to increased mortality.
  • Current guidelines suggest SBP < 120-130 mmHg and DBP < 80 mmHg, but the impact on coronary perfusion is unclear.

Purpose of the Study:

  • To evaluate the effect of varying blood pressures on coronary perfusion and hemodynamics after aortic valve replacement.
  • To compare the performance of different prosthetic aortic valves under simulated physiological conditions.

Main Methods:

  • Hemodynamic assessment of SAPIEN 3 transcatheter aortic valve (TAV), Evolut R TAV, and Magna Ease surgical aortic valve (SAV) in a pulsed left heart simulator.
  • Simulations were conducted at varying SBP, DBP, and heart rates (60 and 120 bpm) with a constant cardiac output of 5 L/min.
  • Calculated average coronary flow (CF), effective orifice areas (EOAs), and valvulo-arterial impedance (Zva).

Main Results:

  • Coronary flow (CF) dropped below physiological limits at SBP < 120 mmHg and DBP < 60 mmHg for several valves at 60 bpm.
  • Valvulo-arterial impedance (Zva) increased and effective orifice areas (EOAs) decreased with rising SBP and DBP.
  • These trends were consistent at 120 bpm, with valve-dependent variations in CF reduction.

Conclusions:

  • In vitro testing showed prosthetic aortic valves can lead to inadequate coronary flow when blood pressure is within target ranges.
  • Findings highlight the critical need for further investigation into optimal blood pressure management strategies for patients post-aortic valve replacement.
Abstract

Keywords:
coronary flowhypertensionsystemic arterial compliancetranscatheter aortic valve replacementvalvulo-arterial impedance

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