Vogl Brennan J, Darestani Yousef M, Lilly Scott M, Thourani Vinod H, Alkhouli Mohamad A, Lindman Brian R, Hatoum Hoda
Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA.
Department of Civil, Environmental and Geospatial Engineering, Michigan Technological University, Houghton, Michigan, USA.
Catheter Cardiovasc Interv. 2022 Mar;99(4):1214-1224. doi: 10.1002/ccd.30052. Epub 2021 Dec 22.
Our objective was to evaluate the impact of various blood pressures (BPs) on coronary perfusion and valvular hemodynamics following aortic valve replacement (AVR).
Lower systolic and diastolic (SBP/DBP) pressures from the recommended optimal target range of SBP < 120-130 mmHg and DBP < 80 mmHg after AVR have been independently associated with increased cardiovascular and all-cause mortality.
The hemodynamic assessment of a 26 mm SAPIEN 3 transcatheter aortic valve (TAV), 29 mm Evolut R TAV, and 25 mm Magna Ease surgical aortic valve (SAV) was performed in a pulsed left heart simulator with varying SBP, DBP, and heart rate (HR) conditions (60 and 120 bpm) at 5 L/min cardiac output (CO). Average coronary flow (CF), effective orifice areas (EOAs), and valvulo-arterial impedance (Zva) were calculated.
At HR of 60 bpm, at SBP < 120 mmHg and DBP < 60 mmHg, CF decreased below the physiological lower limit with several different valves. Zva and EOA were found to increase and decrease respectively with increasing SBP and DBP. The same results were found with an HR of 120 bpm. The trends of CF variation with BP were similar in all valves however the drop below the lower physiological CF limit was valve dependent.
In a controlled in vitro system, with different aortic valve prostheses in place, CF decreased below the physiologic minimum when SBP and DBP were in the range targeted by blood pressure guidelines. Combined with recent observations from patients treated with AVR, these findings underscore the need for additional studies to identify the optimal BP in patients treated with AVR for AS.
我们的目的是评估不同血压对主动脉瓣置换术（AVR）后冠状动脉灌注和瓣膜血流动力学的影响。
主动脉瓣置换术后收缩压和舒张压（SBP/DBP）低于推荐的最佳目标范围（SBP＜120 - 130mmHg且DBP＜80mmHg）已独立与心血管和全因死亡率增加相关。
在脉冲式左心模拟器中，于5L/min心输出量（CO）的情况下，在不同的收缩压、舒张压和心率（HR）条件（60和120次/分钟）下，对26mm SAPIEN 3经导管主动脉瓣（TAV）、29mm Evolut R TAV和25mm Magna Ease外科主动脉瓣（SAV）进行血流动力学评估。计算平均冠状动脉血流（CF）、有效瓣口面积（EOA）和瓣 - 动脉阻抗（Zva）。
在心率为60次/分钟时，收缩压＜120mmHg且舒张压＜60mmHg时，使用几种不同瓣膜时冠状动脉血流低于生理下限。发现Zva和EOA分别随着收缩压和舒张压的升高而增加和降低。心率为120次/分钟时也得到相同结果。所有瓣膜中冠状动脉血流随血压变化的趋势相似，但低于生理下限冠状动脉血流的下降情况因瓣膜而异。
在一个装有不同主动脉瓣假体的体外控制系统中，当收缩压和舒张压处于血压指南所针对的范围内时，冠状动脉血流降至生理最小值以下。结合近期主动脉瓣置换术患者的观察结果，这些发现强调需要进行更多研究以确定主动脉瓣狭窄患者接受主动脉瓣置换术后的最佳血压。
