Myocardial Injury Post Transcatheter Aortic Valve Implantation Comparing Mechanically Expanded Versus Self-Expandable Versus Balloon-Expandable Valves

Abstract

ABSTRACT Background Myocardial injury (MI) is common with transcatheter aortic valve implantation (TAVI) and may predict poor outcome. We aim: 1) to evaluate the difference in change of high-sensitivity-Troponin-T (hsTnT) within 24h after transfemoral-TAVI between mechanically-expanded (MEV), self-expanding (SEV) and balloon-expandable-valves (BEV); 2) to determine predictors for MI post-TAVI; and 3) to assess whether MI is associated with 30-day mortality. Methods This multicenter retrospective observational study included 1208 consecutively treated transfemoral-TAVI patients from three European centers. All patients treated with a MEV, SEV or BEV with available hsTnT measurements at baseline and within 24 h post-TAVI were included. Significant MI was defined as an elevation of hsTnT ≥ 15x the upper-reference-limit. Results Overall, the median hsTnT rise was 741 ng/L and was lower with MEV (MEV 335 vs. SEV 901 vs. BEV 649 ng/L, p < 0.001). MI occurred in 925 patients (77%) and was less frequent with MEV (MEV 67%, SEV 79% and BEV 76%, p = 0.007). Occurrence of MI was similar after implantation of first vs. second- generation SEV (79 vs. 80%, p = 0.72) and BEV (77 vs. 76%, p = 0.90). There was no association between frequency of annulus manipulation and MI. On multivariable analysis (OR (95% CI) non-MEV (1.63 (1.06–2.49)), mean aortic gradient (1.02 (1.01–1.03)), left ventricular ejection fraction (1.03 (1.01–1.04)), and previous myocardial infarction (1.62 (1.04–2.56)) were positively associated with MI. There was no association between MI and 30-day mortality. Conclusion Transcatheter valve design determines peri-procedural MI and is less frequent with MEV. MI is not associated with 30-day mortality.