Post-procedural myocardial infarction following surgical and trans-catheter aortic valve replacement.

Research paper by Laura E LE Dobson, Tarique A TA Musa, Akhlaque A Uddin, Timothy A TA Fairbairn, Peter P PP Swoboda, David P DP Ripley, Pankaj P Garg, Betsy B Evans, Christopher J CJ Malkin, Daniel J DJ Blackman, Sven S Plein, John P JP Greenwood

Indexed on: 25 Jan '17Published on: 25 Jan '17Published in: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology


Myocardial injury assessed using cardiac biomarker release is ubiquitous following surgical (SAVR) and trans-catheter aortic valve implantation (TAVI), preventing accurate discrimination between focal myocardial infarction (MI) and global injury. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging was used to compare rates of new MI following SAVR and TAVI.Identical CMR scans were obtained at baseline and 6m post- procedure in ninety-six patients undergoing SAVR (n=39) and TAVI (n=57). The rate of new MI was greater following SAVR than TAVI (SAVR, n=10(26%) vs. TAVI, n=3(5%), p=0.004). Infarct mass was similar between groups (SAVR 1.1±0.6 vs. TAVI 2.0±1.4g, p=0.395). New MI did not impact on change in LV ejection fraction (SAVR:LGE(+)2.2±4.7 vs. LGE(-)0.90±8.0%, p=0.437, TAVI:LGE(+)-0.9±6.0 vs. LGE(-)2.0±7.8%, p=0.420). 34 patients (60%) in the TAVI group had non-revascularised coronary artery disease (CAD) at the time of TAVI, of whom 3(9%) had new MI.MI is an infrequent complication of TAVI but is more common following SAVR. Infarct size is small following both procedures. The low new infarct rate in TAVI, especially in the context of high rates of non-revascularised CAD strengthens data from previous studies suggesting that coronary revascularisation pre-TAVI may be unnecessary.

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