Continuous Hemodynamic Monitoring During Transcatheter Tricuspid Valve Repair: Insights From Pulse Contour-based...

Area of Science:

• Cardiovascular Medicine
• Medical Devices
• Hemodynamic Monitoring

Background:

• Transcatheter edge-to-edge tricuspid valve repair (T-TEER) is a complex procedure requiring precise hemodynamic management.
• Continuous, real-time hemodynamic monitoring is crucial for optimizing patient outcomes during T-TEER.

Purpose of the Study:

• To evaluate the effectiveness of pulse contour analysis (PCA) for real-time hemodynamic monitoring in patients undergoing T-TEER.
• To determine if continuous PCA monitoring can identify procedural success indicators and enhance perioperative management.

Main Methods:

• Prospective, hypothesis-generating pilot study conducted at a single tertiary care university hospital.
• 12 patients undergoing T-TEER were monitored using real-time PCA from pre-assessment to 4 hours post-procedure.
• Hemodynamic parameters including cardiac output (CO), cardiac index (CI), and stroke volume variation were continuously assessed.

Main Results:

• PCA demonstrated a 30% increase in CO (p=0.0124) and a 0.68 L/min/m² rise in CI (p=0.008) 4 hours post-T-TEER.
• A sustained 3% decrease in stroke volume variation (p=0.009) indicated improved preload conditions.
• Systolic arterial pressure increased by 17 mmHg (p=0.026) upon device implantation, and right atrial v-wave decreased by 8 mmHg (p=0.034).

Conclusions:

• Pulse contour analysis (PCA) provides valuable continuous hemodynamic data during T-TEER.
• PCA effectively characterizes acute hemodynamic responses, revealing significant improvements in CO, CI, and preload stability post-procedure.
• Continuous PCA monitoring can serve as a valuable tool for assessing procedural success and guiding perioperative management in T-TEER.