Hemodynamic response of the aortic valve during dobutamine onset then progressive aortic banding

An increasing number of procedures over the past two decades for aortic stenosis (AS) reflects the combination of an aging population and less invasive transcatheter options. As a result, the hemodynamics of the aortic valve (AV) have gained renewed interest to understand its behavior and to optimize patient selection. We studied the hemodynamic relationship between pressure loss (ΔP) and transvalvular flow (Q) of the normal AV as well as the impact of a variable supravalvular stenosis. Our mechanistic study included 11 healthy swine monitored during dobutamine stress and followed by acute aortic banding to simulate AS. Hemodynamics were continuously recorded, and transvalvular ΔP versus Q were analyzed using proportional and linear models. During dobutamine infusion, normal valves exhibited a highly linear relationship between ΔP and Q (median R² of 0.93). Progressive aortic banding eventually displayed a highly linear relationship between an increasing ΔP and the decreasing Q, characterized by a constant systemic circulatory resistance (median R² of 0.91). Consequently, a normal AV can be described by a single parameter: its resistance, median 0.37 Wood units [WU] in swine. During dobutamine stress and aortic banding, the systemic bed behaves like a constant and stable resistance, median 11.9 WU in swine. These findings carry significant implications for quantifying normal and diseased AV behavior, and potentially might improve patient selection and treatment outcomes.