Left Ventricular Twist Mechanics Before and After Aortic Valve Replacement: A Feasibility Study and Exploratory...

Area of Science:

• Cardiovascular Physiology
• Echocardiography
• Cardiac Surgery

Background:

• Left ventricular (LV) twist mechanics are crucial for cardiac function.
• Intraoperative assessment of LV mechanics can guide surgical management.
• Transesophageal echocardiography (TEE) is a valuable tool for intraoperative cardiac assessment.

Purpose of the Study:

• To determine the feasibility of intraoperative TEE assessment of LV twist mechanics.
• To explore alterations in LV twist mechanics due to hemodynamic conditions and patient comorbidities.
• To examine the impact of aortic valve replacement (AVR) on LV twist mechanics.

Main Methods:

• Sub-analysis of clinical trial data from patients undergoing AVR.
• Collection of transgastric short-axis echocardiographic images for LV twist analysis using 2D speckle-tracking.
• Assessment of LV twist, twisting rate, and untwisting rate at baseline and end of surgery.

Main Results:

• Only 16 out of 40 patients had acceptable TEE images for LV twist analysis.
• LV twist was augmented in patients with aortic stenosis.
• No significant differences in twist mechanics were observed based on diabetes, need for CABG, or use of vasoactive medications.

Conclusions:

• Intraoperative assessment of LV twist mechanics via TEE is feasible but has limitations in image acquisition.
• LV twist mechanics provide insights into LV systolic and diastolic function.
• Twist indices were not significantly affected by reduced afterload, diabetes, or coronary artery disease in this cohort.