The impact of transcatheter aortic valve replacement on changes of coronary computed tomography-derived fractional flow reserve.

Abstract

Background: The effect of transcatheter aortic valve replacement (TAVR) on changes of computed tomography-derived fractional flow reserve (CT-FFR) values was controversial. Thus, we aimed to identify the impact of TAVR on changes of CT-FFR values, plaque characteristics, and the associated clinical impact.

Methods: This single-center observational study included 39 consecutive patients with severe aortic valve disease undergone TAVR between August 2019 and April 2023, whom were performed with preoperative and postoperative coronary CT angiography (CCTA). The computation of CT-FFR and plaque characteristics was performed by an independent central core laboratory.

Results: Each patient underwent CCTA and CT-FFR assessment without encountering any complications. Notably, both at discharge and six months post-TAVR, there was a significant improvement observed in the New York Heart Association (NYHA) functional classification, left ventricular fractional shortening, and ejection fraction compared to pre-operative levels. The CT-FFR for left anterior descending artery (LAD), left anterior descending artery (LCX), and right coronary artery (RCA) had no obvious change at discharge compared to pre-operation (0.92 ± 0.05 vs. 0.93 ± 0.05, p = 0.109; 0.96 ± 0.03 vs. 0.95 ± 0.03, p = 0.523; 0.97 ± 0.04 vs. 0.97 ± 0.03, p = 0.533; respectively). Furthermore, TAVR did not exert a significant impact on plaque burden during the perioperative period.

Our report suggested that TAVR did not significantly affect coronary CT-FFR measurements and plaque characteristics in the perioperative period, and furthermore, the patients' cardiac function showed gradual improvement in the short-term following discharge.