154 Myocardial injury after transcatheter aortic valve implantation: are transfemoral and transapical approaches equal?

Abstract

Transcatheter aortic valve implantation (TAVI) induces a certain amount of myocardial injury assessed by an increase in cardiac troponin after the procedure. The goal of this study was to compare troponin levels after TAVI performed using either the transfemoral (TF) or transapical (TA) route. We enrolled 103 consecutive pts with severe symptomatic aortic stenosis and a high surgical risk who underwent TAVI using the Edwards-Sapien valve. TF TAVI was performed in 74 pts under local anesthesia after surgical cutdown of the femoral artery while the other 29 pts underwent a TA TAVI. For the 2 approaches, the valve was implanted during rapid pacing. Cardiac Troponin I (lower limit of detection: 0.2 μg/l, suggested diagnostic value for myocardial infarction: 1.0 μg/l) was measured before, 8 hours and 24 hours after TAVI. Pts undergoing TA TAVI were significantly more often males (69% vs 45%, p < 0.05), younger (79 ± 8 vs 84 ± 6 years, p < 0.01) and had more often previous bypass surgery (48% vs 23%, p < 0.03) than TF pts. The proportion of pts with previous myocardial infarction, previous PCI, presence of at least one significant (>50%) coronary stenosis at the time of valve implantation, was similar between the TF and TA population. Logistic Euroscore, ejection fraction, creatinin level were similar in the 2 groups. After TAVI, the effective orifice area increased from 0.65 ± 0.15 to 1.90 ± 0.30 cm 2 (p < 0.0001) and the transvalvular mean gradient decreased from 44 ± 14 to 9 ± 4 mmHg (p < 0.0001). While troponin level was similar at baseline in the TF and TA populations (0.06 ± 0.14 μg/l TF vs 0.11 ± 0.34 μg/l TA), peak troponin was very significantly higher after TA TAVI than after TF TAVI (65.20 ± 61.06 μg/l TA vs 5.23 ± 7.94 μg/l TF, p < 0.001). Troponin elevation after TA TAVI is much higher than after TF TAVI. Whether theses differences in the degree of myocardial injury have prognostic value will require further studies.