title: Early hemodynamic and neurohormonal response after transcatheter aortic valve implantation.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiology Department, Segeberger Kliniken GmbH, Bad Segeberg, Germany. mohammad_sherif@hotmail.com
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Sherif
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Omar
authors.initials: O
authors.lastname: Awad
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.forename: Ghada
authors.initials: G
authors.lastname: El-Shahed
authors.forename: Reinhard
authors.initials: R
authors.lastname: Semmler
authors.forename: Mazen
authors.initials: M
authors.lastname: Tawfik
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Doreen
authors.initials: D
authors.lastname: Richardt
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Ralph
authors.initials: R
authors.lastname: Tölg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D045265:Natriuretic Peptides / Q000097:blood*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D045265:Natriuretic Peptides