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Post-procedural myocardial infarction following surgical aortic valve replacement and transcatheter aortic valve

Laura E Dobson1, Tarique A Musa, Akhlaque Uddin

  • 1Multidisciplinary Cardiovascular Research Centre (MCRC) & Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, United Kingdom.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|January 25, 2017
PubMed

Insights

Myocardial infarction (MI) is less common after transcatheter aortic valve implantation (TAVI) than surgical aortic valve replacement (SAVR). Cardiovascular magnetic resonance imaging shows new MI occurs more frequently with SAVR, with small infarct sizes in both procedures.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Myocardial injury is common after aortic valve replacement procedures, making it hard to distinguish focal myocardial infarction (MI) from global injury.
  • Cardiac biomarker release is a standard but imprecise measure of myocardial injury post-SAVR and TAVI.
  • Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) offers a more precise method to assess myocardial injury.

Purpose of the Study:

  • To compare the rates of new myocardial infarction (MI) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).
  • To utilize Cardiovascular Magnetic Resonance (CMR) late gadolinium enhancement (LGE) imaging to quantify and compare myocardial injury between SAVR and TAVI.
  • To evaluate the impact of new MI on left ventricular ejection fraction changes post-procedure.

Main Methods:

  • Ninety-six patients (39 SAVR, 57 TAVI) underwent identical CMR scans at baseline and six months post-procedure.
  • Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) was used to detect and quantify new myocardial infarction (MI).
  • Patient data included procedural type, presence of coronary artery disease (CAD), and changes in left ventricular ejection fraction.

Main Results:

  • The rate of new myocardial infarction (MI) was significantly higher following SAVR (26%) compared to TAVI (5%) (p=0.004).
  • Infarct mass was similar between the groups, indicating small infarct sizes regardless of the procedure.
  • New MI did not significantly impact the change in left ventricular ejection fraction in either the SAVR or TAVI groups.

Conclusions:

  • Myocardial infarction (MI) is an infrequent complication of TAVI but more common after SAVR.
  • The infarct size is small following both SAVR and TAVI.
  • The low rate of new MI in TAVI patients, even with significant coronary artery disease, suggests pre-procedural revascularization may not always be necessary.
Abstract

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