Hemodynamic Consequences of Two Different Surgical and AnestheticTechniques for the Treatment of Aortic Valve Stenosis - A RandomizedComparison

There are two substantially different methods of doing aortic valve replacement in elderly patients with severe aortic valve stenosis: The trans-apical aortic valve replacement (TAVI) and the standard surgical aortic valve replacement (SAVR). The impact of surgery as well as anesthesia has great influence on perioperative hemodynamics. We compared the perioperative hemodynamic variables in comparable groups of patients going through either of these procedures. Methods: The present study is a subset of the STACATO trial, which was a multicenter trial with the objective of comparing the two treatment methods in patients with significant valvular aortic stenosis who were eligible for either procedure. This study analyses hemodynamic data as well as arterial blood gases and s-creatinine from the 58 randomized patients in our institution. Results: Patients in the SAVR group had lower values of cardiac index (CI) and stroke volume index (SVI) than the TAVI group at all times (p<0.001). At the end of surgery the SAVR group had a higher pO2 (p<0.0001), a higher s-lactate (p=0,003) and a lower hematocrit (p=0,045) than the TAVI group and in the postoperative period the pH was closer to normal in the TAVI group. The perioperative fluid balance was higher in the SAVR group (p<0.0001). A more pronounced increase in s-creatinine (p=0.034) was seen in the TAVI group. There were no differences in the perioperative use of inotropes, vasoconstrictors or vasodilators. Conclusions: The main finding in the present study was that the surgical and anesthesiological management of TAVI resulted in more stable hemodynamics both per- and postoperatively compared to SAVR patients.