Transcatheter Aortic Valve Implantation (TAVR): The Impact of Prosthesis Positioning on Valvular and Coronary Hemodynamics

What this Trial Is About

This research aims to better understand how the positioning of a transcatheter aortic valve replacement (TAVR) prosthesis affects blood flow in the heart and coronary arteries. The study focuses on whether cardiac magnetic resonance imaging (CMRI) and echocardiography can offer alternatives to computer tomography for evaluating valve alignment. It also investigates how the valve's position, especially its symmetry and commissural alignment, impacts blood flow through the valve and aorta, as well as coronary flow after TAVR. Participants in this study will have undergone transfemoral TAVR and will receive diagnostic imaging assessments including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging. These imaging tests will be used to evaluate valve positioning, blood flow characteristics, and coronary flow. The study examines the presence of commissural alignment and symmetry, as well as measures like transvalvular gradients, effective orifice area, paravalvular leakage, turbulent flow, coronary flow reserve, and heart function. Throughout the study, participants will undergo imaging assessments shortly after TAVR to collect detailed data on valve and coronary blood flow. Researchers will monitor various parameters such as pressure recovery, energy loss, wall shear stress, and ventricular function. The findings aim to guide future improvements in valve implantation techniques to enhance valve durability and coronary access. The study is led by Heinrich-Heine University, Duesseldorf, and involves no masking or placebo control.

TAVR: The Impact of Prothesis Positioning on Valvular and Coronary Hemodynamics