Elsevier

American Heart Journal

Volume 160, Issue 5, November 2010, Pages 862-869
American Heart Journal

Clinical Investigation
Valvular and Congenital Heart Disease
Early hemodynamic and neurohormonal response after transcatheter aortic valve implantation

https://doi.org/10.1016/j.ahj.2010.07.017Get rights and content

Background

The conventional surgical aortic bioprostheses used for treatment of aortic stenosis (AS) are inherently stenotic in nature. The more favorable mechanical profile of the Medtronic CoreValve bioprosthesis may translate into a better hemodynamic and neurohormonal response.

Patients and Methods

The early hemodynamic and neurohormonal responses of 56 patients who underwent successful transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve bioprosthesis for severe symptomatic AS were compared with those of 36 patients who underwent surgical aortic valve replacement (SAVR) using tissue valves in the same period.

Results

At baseline, patients in the TAVI and SAVR group had comparable indexed aortic valve area (0.33 ± 0.1 vs 0.34 ± 0.1 cm2, respectively; P = .69) and mean transvalvular gradient (51.1 ± 16.5 vs 53.1 ± 14.3 mm Hg, respectively; P = .56). At 30-day follow-up, mean transvalvular gradient was lower in the TAVI group than in the SAVR group (10.3 ± 4 vs 13.1 ± 6.2 mm Hg, respectively; P = .015), and the indexed aortic valve area was larger in the TAVI group (1.0 ± 0.14 vs 0.93 ± 0.13 cm2/m2; P = .017). There was a trend toward a higher incidence of moderate patient-prosthesis mismatch in the surgical group compared with the TAVI group (30.5% vs 17.8%, respectively; P = .11). The overall incidence of prosthetic regurgitation (any degree) was higher in the TAVI group than in the SAVR group (85.7% vs 16.7%, respectively; P < .00001). The left ventricular mass index decreased after TAVI (175.1 ± 61.8 vs 165.6 ± 57.2 g/m2; P = .0003) and remained unchanged after SAVR (165.1 ± 50.6 vs 161 ± 64.8 g/m2; P = .81). Similarly, NT-ProBNP decreased after TAVI (3,479 ± 2,716 vs 2,533 ± 1,849 pg/mL; P = .033) and remained unchanged after SAVR (1,836 ± 2,779 vs 1,689 ± 1,533 pg/mL; P = .78). There was a modest correlation between natriuretic peptides and left ventricular mass index in the whole cohort (r = 0.4, P = .013).

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 early initiation of a reverse cardiac remodeling process and a decrease in natriuretic peptides.

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.

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