title: Hemodynamic results and changes in myocardial function after transcatheter aortic valve implantation.
abstract: BACKGROUND
  This prospective study was designed to evaluate the hemodynamic results of transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis (Medtronic, Minneapolis, Minnesota) and the effects on left ventricular function.
  
  
  METHODS
  From June 2008 to June 2009, consecutive patients with severe symptomatic aortic valve stenosis (aortic valve area <1 cm(2)) and the indication for TAVI were included. Aortic valve prosthesis was inserted retrograde. Examinations of study patients were performed before, 30 days, and 6 months after TAVI and comprised measurement of B-type natriuretic peptide and echocardiography. Severe prosthesis-patient mismatch was defined as an indexed effective aortic valve area < or =0.65 cm(2)/m(2).
  
  
  RESULTS
  In 39 patients, follow-up examinations were performed after TAVI. Severe prosthesis-patient mismatch seldom occurred (n = 1), but mild to moderate aortic valve regurgitation due to paravalvular leaks was common (n = 24, 62%). After 6 months, left ventricular mass index declined (158 +/- 46 vs 138 +/- 45 g/m(2), P = .001), and peak early diastolic mitral annular velocity (E') and peak systolic mitral annular velocity (S') increased (P = .004 and P < .001, respectively). B-type natriuretic peptide levels decreased (744 +/- 708 at baseline vs 367 +/- 273 at 30 days, P = .003, 279 +/- 186 pg/mL at 6 months, P = .001). Left ventricular diameters and ejection fraction remained unchanged.
  
  
  CONCLUSIONS
  Despite the high incidence of paravalvular regurgitation after TAVI, hemodynamic results were favorable. Furthermore, TAVI had positive effects on left ventricular remodeling and improved neurohormonal activity, myocardial hypertrophy, and diastolic function.
authors.affiliation: BG-Kliniken Bergmannsheil, Medical Clinic II, Ruhr-University Bochum, Germany. michael_gotzmann@web.de <michael_gotzmann@web.de>
authors.forename: Michael
authors.initials: M
authors.lastname: Gotzmann
authors.forename: Michael
authors.initials: M
authors.lastname: Lindstaedt
authors.forename: Waldemar
authors.initials: W
authors.lastname: Bojara
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
authors.forename: Alfried
authors.initials: A
authors.lastname: Germing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002306:Cardiac Volume; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
chemical_list: D020097:Natriuretic Peptide, Brain