title: Impact of type of intervention for aortic valve replacement on heart rate variability.
abstract: BACKGROUND
  It is known that coronary heart surgery leads to varying degrees of cardiac autonomic derangement, clinically detectable as depression of heart rate variability (HRV) parameters. Few studies report that also surgical replacement of the aortic valve (SAVR) may lead to HRV abnormalities, while very little is known about the autonomic effects obtained after less invasive aortic valve replacement techniques. The study aimed to evaluate HRV after SAVR and to compare it with two less invasive techniques, transapical (TaAVI) and tranfemoral (TfAVI) aortic valve implant.
  
  
  METHODS
  Time-domain heart rate variability (HRV) parameters have been studied by 24-h Holter ECG in 129 patients after SAVR, in 63 patients after TfAVI and in 19 patients after TaAVI.
  
  
  RESULTS
  All HRV parameters were significantly depressed in SAVR, while they were almost completely preserved in TfAVI patients; TaAVI cases showed a somehow intermediate behaviour [(SDNN respectively: 71.0±34.9 vs 95.9±29.5 (p<0.001) vs 84.4±32.6ms (p=ns)]. Mean heart rate during the 24-h Holter was 8% higher in SAVR patients than in both TfAVI and TaAVI patients. The reported results were not correlated with echocardiographic ejection fraction, or presence of abnormal glucose metabolism, or degree of anaemia or treatment with beta-blockers.
  
  
  CONCLUSIONS
  SAVR leads to profound depression of some cardiac autonomic parameters, while less invasive procedures allow better preservation of HRV. In particular TfAVI does not induce any significant deterioration of HRV parameters and seems to be the strategy of valve implant with less impact on the cardiovascular autonomic system.
authors.affiliation: Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Cortina d'Ampezzo (BL), Italy; Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy. Electronic address: L.compostella@alice.it.
authors.forename: Leonida
authors.initials: L
authors.lastname: Compostella
authors.affiliation: Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Cortina d'Ampezzo (BL), Italy; Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Russo
authors.affiliation: Dpt Medicine, School of Emergency Medicine, University of Padua, Padova, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Compostella
authors.affiliation: Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Setzu
authors.affiliation: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors.forename: Giambattista
authors.initials: G
authors.lastname: Isabella
authors.affiliation: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Cortina d'Ampezzo (BL), Italy; Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bellotto
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000503:physiopathology; D001021:Aortic Valve / Q000187:drug effects / Q000601:surgery; D001341:Autonomic Nervous System / Q000503:physiopathology*; D000082882:Bicuspid Aortic Valve Disease; D015716:Electrocardiography, Ambulatory; D005260:Female; D044882:Glucose Metabolism Disorders / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology*; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Aortic surgery; Autonomic nervous system; Heart rate variability; TAVI