Objectives. To describe short-term clinical and echocardiography outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). To explore patient selection criteria for treatment with TAVI.Design. TAVI patients (n=45) were matched to SAVR patients (n=45) with respect to age within ±10 years, sex and systolic left ventricular function.Results. TAVI patients were older, 82±8 vs. 78±5 years (p=0.005) and they had higher logEuroSCORE, 16±11% vs. 8±4% (p<0.001). There were no significant differences in 30 day mortality, stroke and myocardial infarction. TAVI patients received less erythrocyte (53% vs. 78%, p=0.03) and thrombocyte (7% vs. 27%, p=0.02) transfusions. Postoperative atrial fibrillation was less common (18% vs. 60%, p<0.001) in the TAVI group. Paravalvular regurgitation was more common in TAVI patients (87% vs. 0%, p<0.001) and 27% had access site complications. Aortic transvalvular velocity was 2.3±0.4 m/s vs. 2.6±0.5 m/s (p=0.002) and mean valve pressure gradient was 12±4 mmHg vs. 15±5 mmHg, (p=0.01) in the TAVI and SAVR groups respectively. Twenty-nine (64%) of the TAVI patients had logEuroSCORE <15%.Conclusions. Both TAVI and SAVR have good short term clinical outcome with excellent hemodynamic result. In clinical practice, factors other than high logEuroSCORE play an important role in patient selection for TAVI.

ObjectiveTo evaluate the relevance of the individual components of the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infarction (MI) in transcatheter aortic valve implantation (TAVI). The association between biomarkers and adverse procedural outcome has been established. However, the additive prognostic importance of signs and symptoms are more uncertain.MethodsA total of 125 consecutive TAVI patients were prospectively included in this study. Biomarkers for MI were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records.ResultsThe criteria of elevated biomarkers and of signs or symptoms were found in 27 (22%) and 32 (26%) of the patients, respectively. According to VARC-2 definition, 12 (10%) had MI. VARC-2 definition of MI, Troponin T (TnT) > 600 ng/L, and presence of signs or symptoms correlated with 6 months mortality, prolonged ICU stay, elevation of N-terminal prohormone brain natriuretic peptide, and renal impairment. No signs or symptoms were found in 7 (44%) of the patients who fulfilled the criterion of elevated TnT > 600 ng/L. In the group with positive TnT criterion, there were no significant differences between those with and without signs or symptoms in respect to levels of TnT (1014 [585–1720] ng/L versus 704 [515–905] ng/L, p = 0.17) or creatine kinase-MB (36 [25–52] μg/L versus 29 [25–39] μg/L, p = 0.32). In the multivariate Cox regression analysis, TnT > 600 ng/L was the only significant independent variable associated with 6-months postprocedural mortality.ConclusionsMyocardial injury in TAVI, measured with biomarkers, correlates well with adverse procedural outcome. In this study it is also the strongest predictor for early postprocedural mortality. The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinically significant MI.

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