Non-Invasive Hemodynamic Monitoring in Transcatheter Aortic Valve Implantation

TL;DR

This study compares non-invasive and invasive hemodynamic monitoring during heart valve implantation procedures.

Contribution

The study evaluates the ClearSight® system as a non-invasive alternative to traditional invasive monitoring during TAVI.

Findings

Non-invasive measurements of cardiac output, cardiac index, and stroke volume were consistently lower than invasive measurements.

Non-invasive blood pressure readings were lower than invasive measurements before and after TAVI.

The correlation between non-invasive and invasive measurements was low with a mean percentage error of 52%.

Abstract

Background/Objectives: Aortic valve stenosis (AS) is a prevalent cardiovascular condition among elderly patients frequently treated with Transcatheter Aortic Valve Implantation (TAVI). Traditional hemodynamic monitoring during TAVI relies on invasive methods. The ClearSight® Finger Cuff system offers a non-invasive alternative for continuous hemodynamic monitoring. To compare the reliability and feasibility of non-invasive hemodynamic monitoring with traditional invasive hemodynamic monitoring during TAVI procedures. Methods: In this prospective observational study, patients undergoing elective TAVI were recruited from two tertiary hospitals between March and August 2023. Invasive hemodynamic measurements were obtained using arterial and pigtail catheters, with a subset undergoing right heart catheterization. Non-invasive measurements were captured using the ClearSight® system. Data on baseline characteristics, procedural details, and 30-day follow-up outcomes were collected. Results: The study cohort comprised 50 patients (median age 82 years (IQR 78.0, 85.8), 50% female). Non-invasive measurements of cardiac output (CO), cardiac index (CI), and stroke volume (SV) were consistently lower than invasive measurements (CO: 4.1 vs. 4.8 L/min, p = 0.03; CI: 2.2 vs. 2.7 L/min/m2, p = 0.01, SV: 66 vs. 77 mL, p = 0.25). Non-invasive blood pressure readings were lower than invasive radial and aortic measurements before and after TAVI. Correlation of non- and invasive measurements was low but similar before and after TAVI (Mean percentage error of 52%). Conclusions: The ClearSight® system provided lower absolute values for all evaluated hemodynamic parameters as well as low correlation compared to traditional methods pre- as well as post-interventional.

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