Myocardial injury after transaortic versus transapical transcatheter aortic valve replacement

Authors: Barbosa Ribeiro, HenriqueDahou, AbdellazizUrena Alcazar, MarinaCarrasco, José LuisMohammadi, SiamakDoyle, DanielLe Ven, FlorentAllende, RicardoAmat Santos, Ignacio J.Paradis, Jean-MichelDeLarochellière, RobertPuri, RishiAbdul-Jawad Altisent, OmarDel Trigo, MariaCampelo-Parada, FranciscoPibarot, PhilippeDumont, ÉricRodés-Cabau, Josep
Abstract: Background : The release of cardiac biomarkers of myocardial injury after transcatheter aortic valve replacement (TAVR) is common, but no data exist on patients undergoing TAVR through a transaortic approach. We aimed to evaluate the incidence and prognostic significance of the increase in cardiac biomarkers in nontransfemoral TAVR candidates, comparing transaortic and transapical approaches. Methods : After excluding patients deemed suitable for transfemoral TAVR, 251 consecutive patients (transaortic, 45; transapical, 206) were prospectively evaluated. Creatine kinase–myocardial band and cardiac troponin T levels were measured at baseline and at 6, 12, 24, 48, and 72 hours after TAVR. Baseline and 6- to 12-month echocardiographic and clinical follow-up were performed. Results : After TAVR, cardiac troponin T increased above the upper normal values in all patients (peak value 0.64 µg/L [IQR, 0.39 to 1.03 µg/L]), whereas creatine kinase–myocardial band levels increased in 88% of patients (transaortic 51%, transapical 96%, p < 0.001; peak value 20.1 µg/L [interquartile range, 14.3 to 31.6 µg/L]). Compared with the transaortic approach, the transapical approach was associated with a greater rise in both cardiac biomarkers (p < 0.001 for both), and a lesser improvement in left ventricular ejection fraction (p = 0.058) and global longitudinal strain (p = 0.039) at 6- to 12-month follow-up. Greater increases of cardiac troponin T levels were independently associated with 30-day and 1-year overall and cardiovascular mortality (p < 0.001 for all). A 15-fold rise in cardiac troponin T levels was the optimal threshold for determining poorer outcomes (p < 0.001). Conclusions : Periprocedural TAVR-related myocardial injury in nontransfemoral candidates was demonstrated in all patients, but the transapical approach was associated with significantly greater myocardial injury compared with the transaortic approach. A higher degree of myocardial injury translated into reduced left ventricular function improvement and lower early and midterm survival rates.
Document Type: Article de recherche
Issue Date: 1 June 2015
Open Access Date: Restricted access
Document version: VoR
This document was published in: The annals of thoracic surgery, Vol. 99 (6), 2001–2009 (2015)
Little, Brown & Co.,
Alternative version: 10.1016/j.athoracsur.2015.01.029
Collection:Articles publiés dans des revues avec comité de lecture

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