Abstract 10633: Sleep Disordered Breathing in Patients Undergoing Transfemoral Aortic Valve Implantation for Severe Aortic Stenosis
Purpose: Sleep disordered breathing (SDB) with obstructive (OSA) or central (CSA) respiratory events is of major prognostic impact for patients with cardiovascular disease. We examined the prevalence of SDB in patients with severe aortic valve stenosis before and after transfemoral aortic valve implantation (TAVI).
Methods: A total of 79 patients (50 % males, average age 83.0 ± 6.3 years) had cardiorespiratory polygraphy (PG) screening before TAVI. A subgroup of 62 patients (48.4 % males, mean age 82.5 ± 6.5 years) underwent a second PG screening 21.0 ± 4.7 days after TAVI.
Results: In this cohort, 49 (62.0%) patients had OSA, 25 (31.6%) CSA and only 5 (6.3%) presented without significant SDB (apnoea-hypopnoa-index, AHI <5/h). From the 62 patients evaluated before and after valve implantation 36 (58.1%) had OSA, 21 (33.8%) presented with CSA and no SDB was detected in 5 patients (8.0 %). As measured by AHI SDB was more severe in CSA compared to OSA (34.5±18.3/h vs. 18.0±12.6/h, p<0.001). Successful TAVI had a significant impact on CSA, but not on OSA: patients with optimal TAVI results (aortic valve regurgitation, AI ≤ grade 1) demonstrated a significant reduction of central respiratory events (39.6±19.6/h to 23.1±16.0/h, p=0.035), while no changes were detected regarding OSA (18.8±13.0/h to 20.25±13.4/h, p=0.376). In contrast, patients with primarily suboptimal TAVI results (AI ≥ 2) presented with no change in OSA (10.5±7.8/h to 12.5±5.0/h, p=0.5) and an increase in central respiratory events (26.3±13.2/h to 39.2±18.4/h p= 0.036)
Conclusion: 1. There is a high prevalence of OSA and CSA in patients with severe aortic valve stenosis in TAVI candidates. 2. Successful TAVI had no significant impact on OSA, but improved CSA significantly. 3. TAVI resulting in moderate to severe aortic valve insufficiency is accompanied with a deterioration of CSA. 4. Presence of CSA after TAVI may indicate prognostic relevant hemodynamic alterations like AI and/or heart failure.
- © 2012 by American Heart Association, Inc.