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American Heart Association

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Final ID: Mo4162

Aortic Valve Hemodynamics in Liver Cirrhosis

Abstract Body (Do not enter title and authors here): Aortic valve stenosis (AS) is often a contraindication to liver transplantation (LT). Despite the widely accepted impact of liver cirrhosis on aortic valve hemodynamics, the change in these parameters with LT or impact of AS on LT outcomes has not been described. Given the rising burden of both AS and liver disease, there is an urgent need to understand this interaction. We identified 674 patients with liver cirrhosis who received LT at UCLA from 1/1/2013 to 12/31/2023 and investigated the change in echocardiographic hemodynamics within a year of the procedure. Patients with severe AS were excluded due to sparsity of these patients in the LT cohort. Aortic valve peak velocity (AVVmax) increased steadily as patients neared transplant and dropped significantly immediately after transplantation (Figure 1A). There was a larger magnitude of change in pre- to post-LT AVVmax in patients with moderate (2.0 vs 1.6 m/s, p < 0.001) as compared to mild AS (1.5 vs 1.4 m/s, p < 0.001) in analysis of variance models. When patients were sorted by ascending pre-operative AVVmax, the magnitude of fall in AVVmax steadily increased (Figure 1B). There was a similar change in mean gradients whereas aortic valve area and dimensionless index remained unchanged after LT. There was a significant decrease in all other echocardiographic parameters associated with volume after LT: biatrial volume and pressure, and biventricular size. There was a 5.5% drop in left ventricular ejection fraction (LVEF) after LT that was statistically significant in confounder-controlled regression models (p<0.001) and negatively correlated with increasing preoperative AVVmax (-6.2%/ms-1, p = 0.02). The presence of mild or moderate aortic stenosis was not associated with a change in 30-day or 1-year mortality, need for intraoperative vasopressor or peri-operative blood products. Overall, our findings suggest that markers of volume and aortic transvalvular flow decrease after LT without significant change in aortic valve area. There is a significant post-operative fall in LVEF, the magnitude of which is proportional to pre-operative AVVmax. Mild or moderate pre-operative AS are not associated with worse mortality or need for perioperative support.
  • Zinoviev, Radoslav  ( University of California, Los Angeles , University Hts , Ohio , United States )
  • Aksoy, Olcay  ( UCLA , Los Angeles , California , United States )
  • Author Disclosures:
    Radoslav Zinoviev: DO NOT have relevant financial relationships | Olcay Aksoy: No Answer
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Advances in Valvular Heart Disease: Risk Factors, Surgical Outcomes, and Management

Monday, 11/18/2024 , 10:30AM - 11:30AM

Abstract Poster Session

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