Clinical InvestigationValvular and Congenital Heart DiseaseEarly hemodynamic and neurohormonal response after transcatheter aortic valve implantation
Section snippets
Study design and patients
Between September 2007 and May 2009, 56 consecutive patients with severe symptomatic AS (aortic valve area [AVA] <1 cm2 or body surface area indexed AVA [iAVA] <0.6 cm2/m2) underwent successful TAVI using the Medtronic CoreValve (Medtronic CoreValve, Irvine, CA) bioprosthesis via the transfemoral route. Clinical and anatomical selection criteria and device size selection were in line with the published investigational study for the third-generation (18F) CoreValve device.8, 9 Description of the
Baseline hemodynamic and neurohormonal characteristics
Baseline clinical, hemodynamic, and neurohormonal characteristics are shown in Table I, Table II. The TAVI patients, according to patient selection, had a higher mean logistic EuroSCORE15 (22.6% vs 6.7%; P < .001), were 8 years older, and had worse New York Heart Association (NYHA) class (P < .001) compared with SAVR patients. At baseline, patients in the TAVI and SAVR groups had comparable iAVA (0.33 ± 0.1 vs 0.34 ± 0.1 cm2/m2, respectively; P = .69) and mean transvalvular gradient (51.1 ±
Discussion
The short-term hemodynamic and neurohormonal results of this study demonstrate the efficacy of TAVI using the Medtronic CoreValve bioprosthesis in managing high surgical risk patients who have severe calcific AS.
Conclusion
In patients with severe AS, TAVI resulted in lower transvalvular gradients and higher valve areas than SAVR. Such hemodynamic performance after TAVI may have contributed to an earlier initiation of the reverse cardiac remodeling process and a decrease in natriuretic peptides.
Acknowledgement
Our thanks to the clinical research group at the Heart and Vascular Centre, Segeberger Kliniken GmbH, especially Mrs Daniela Schuermann-Kuchenbrandt and Mr Guido Kassner.
References (26)
- et al.
Plasma levels of brain and atrial natriuretic peptides elevate in proportion to left ventricular end-systolic wall stress in patients with aortic stenosis
Am Heart J
(1997) - et al.
Natriuretic peptides in patients with aortic stenosis
Am Heart J
(2001) - et al.
Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome
J Am Coll Cardiol
(2007) - et al.
Determination of the stenotic aortic valve area in adults using Doppler echocardiography
J Am Coll Cardiol
(1986) - et al.
Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings
Am J Cardiol
(1986) - et al.
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography
J Am Soc Echocardiogr
(2003) - et al.
Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis
J Am Coll Cardiol
(2009) - et al.
Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up
Am Heart J
(1999) - et al.
Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology
Eur Heart J
(2007) - et al.
Transcatheter aortic valve replacement: a potential option for the nonsurgical patient
Clin Cardiol
(2009)
Prognostic value of N-terminal pro-B-type natriuretic peptide for conservatively and surgically treated patients with aortic valve stenosis
Heart
The effect of aortic valve replacement on N-terminal natriuretic propeptides in patients with aortic stenosis
Clin Cardiol
Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis
Circulation
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Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement: Is the Problem Solved?
2018, Interventional Cardiology ClinicsProsthesis-patient mismatch after transcatheter aortic valve implantation
2016, Annals of Thoracic SurgeryCitation Excerpt :Furthermore, optimal position (defined as 5 to 10 mm below the native aortic annulus measured fluoroscopically) was also inversely correlated to PPM occurrence (optimal position: 61.8% of patients without PPM vs 25.0% of patients with PPM; p = 0.015) [14]. Six studies [8, 10, 12, 16, 21, 22], including a total of 745 patients (399 TAVI vs 346 SAVR), reported direct comparison of PPM prevalence after TAVI versus SAVR (Table 1). The second meta-analyses found statistically significant reductions in moderate (odds ratio [OR] 0.36; 95% CI: 0.14 to 0.90; p = 0.03), severe (OR 0.36; 95% CI: 0.20 to 0.63; p = 0.0003), and overall PPM prevalence (OR 0.23; 95% CI: 0.07 to 0.79; p = 0.02) after TAVI relative to SAVR (Fig 4).
Effect of B-type Natriuretic Peptides on Long-Term Outcomes after Transcatheter Aortic Valve Implantation
2015, American Journal of CardiologyIncreased mortality after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and low ejection fraction: A meta-analysis of 6898 patients
2014, International Journal of CardiologyCitation Excerpt :56 studies were subsequently excluded and therefore, 26 studies were finally included in the analyses, enrolling 6898 patients. No significant limitations were identified for 26 trials, 1 of which was a randomized comparison [5], while 25 were observational studies [3,7,11,12,15,17,18,25–40]. In patients with low EF, overall mortality risk post TAVI was significantly increased, as demonstrated by the pooled estimate for overall incidence of 30-day (ES: 0.13; 95% confidence interval [CI]: 0.01 to 0.25, I2 = 49.65, Q = 21.85; Fig. 2A), 6-month (ES: 0.32; 95% [CI]: 0.08 to 0.55, I2 = 12.66, Q = 1.14; Fig. 2B) and 1-year-all-cause mortality (ES: 0.25; 95% [CI]: 0.16 to 0.34, I2 = 25.57, Q = 16.12; Fig. 2C), compared to patients with normal EF.