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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Early hemodynamic and neurohormonal response after transcatheter aortic valve implantation
American Heart Journal, Volume 160, No. 5, Year 2010
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Description
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 cm 2/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. © 2010 Mosby, Inc.
Authors & Co-Authors
Sherif, Mohammad A.
Germany, Bad Segeberg
Segeberger Kliniken Gmbh
Egypt, Cairo
Ain Shams University Hospitals
Abdel-Wahab, Mohamed Kader
Germany, Bad Segeberg
Segeberger Kliniken Gmbh
Egypt, Cairo
Ain Shams University Hospitals
Awad, Omar
Egypt, Cairo
Ain Shams University Hospitals
Geist, Volker
Germany, Bad Segeberg
Segeberger Kliniken Gmbh
El-Shahed, Ghada S.
Egypt, Cairo
Ain Shams University Hospitals
Semmler, Reinhard
Germany, Bad Segeberg
Segeberger Kliniken Gmbh
Tawfik, Mazen
Egypt, Cairo
Ain Shams University Hospitals
Khattab, Ahmed A.
Egypt, Cairo
Ain Shams University Hospitals
Richardt, Doreen
Germany, Lubeck
Universitätsklinikum Schleswig-holstein Campus Lübeck
Richardt, Gert
Germany, Bad Segeberg
Segeberger Kliniken Gmbh
Toelg, Ralph
Germany, Bad Segeberg
Segeberger Kliniken Gmbh
Statistics
Citations: 38
Authors: 11
Affiliations: 3
Identifiers
Doi:
10.1016/j.ahj.2010.07.017
ISSN:
00028703
e-ISSN:
10976744
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study