Autonomic Control and Baroreflex Sensitivity Before and After Transcatheter Aortic Valve Implantation

Transcatherer aortic valve implantation (TAVI) is preferred in patients with aortic stenosis and high surgical risk. In this category of patients, the assessment of cardiovascular control and baroreflex, especially during a postural challenge evoking an autonomic response could improve risk stratification. Cardiovascular control and baroreflex were here assessed in 22 patients (age: 80.73±6.63 yrs, 9 females) scheduled for TAVI studied one day before (PRE) and within 7 days after the intervention (POST) via the analysis of heart period (HP) and systolic arterial pressure (SAP) at rest in supine position (REST) and during active standing (STAND). Time and frequency domain markers were computed to quantify cardiovascular control and cross-spectral indexes from SAP to HP to estimate baroreflex sensitivity. At REST a tendency towards an increased sympathetic modulation and vagal withdrawal was observed in POST compared to PRE, thus resulting in a significant decrease of baroreflex sensitivity after TAVI. STAND induced a post-procedural increase of the sympathetic modulation during POST. Results suggest a more reactive sympathetic control after TAVI in presence of a depressed baroreflex function and this situation could lead to a greater exposition of TAVI patients to develop post-implantation adverse events.