Advanced Haemodynamic Monitoring During Transfemoral Aortic Valve Replacement: A Prospective Pilot Study

This pilot study aims to compare advanced and standard haemodynamic monitoring during TAVI in terms of predicting and avoiding hypotension. Intraoperative hypotension influences postoperative outcomes by increasing mortality, renal failure, and cardiac complications. In TAVI (transaortic valve implantation), haemodynamic stability is essential because the patients are usually old and vulnerable. Fifty patients underwent transfemoral TAVI under standard anaesthetic care. Blood pressure was measured invasively, using Edwards Acumen sensors connected to a HemoSphere monitor. The signal was simultaneously fed to anaesthesia monitors. Patients were randomly divided into two groups: in the test group, the Edwards monitor with the HPI (hypotension prediction index) values was available to the anaesthetist, whereas in the control group, the HemoSphere monitor was covered. The primary endpoint of the study was the time-weighted average of intraoperative hypotension, which is calculated from the intensity and duration of hypotension, adjusted for the duration of surgery (TWA₆₅). Secondary endpoints were the cumulative time of hypotensive episodes adjusted for the duration of the procedure (TWA_total). No difference in intraoperative hypotension in terms of TWA₆₅ between control and intervention group could be detected, the overall duration of intraoperative hypotension was reduced in the intervention group, and the administration of intraoperative volume was higher in the intervention group when compared to controls. The use of HPI during TAVI leads to improved haemodynamic stability, and this is particularly important in these extremely vulnerable patients. Not only is it possible to reduce overall intraoperative hypotension with HPI, but postoperative complications associated with intraoperative hypotension that might occur will also be diminished.