Predictors and Impact of Myocardial Injury After Transcatheter Aortic Valve Replacement

Abstract

Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function.

Clinical and hemodynamic results after direct transcatheter aortic valve replacement versus pre‐implantation balloon aortic valvuloplasty: A case‐matched analysis

“…Also cardiac biomarkers were significantly lower in the direct TAVR group, translating to a fewer myocardial injury after TAVR, probably related to less rapid pacing stimulation and a more simple procedure. Future studies will have to determine if avoiding this myocardial damage might translate to better LVEF recovery and clinical outcomes . Other peri‐procedural complications, such as major bleeding, vascular complication, or myocardial infarction, were not increased in the direct TAVR group.…”

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

“…3,12 There are several studies to show that new pacemaker implantation, as well as myocardial injury, are associated with worse outcome. [3][4][5][6]22 In our study, there was no association between myocardial injury and 30-day mortality. One can only speculate on how the finding of less myocardial injury would compare to the higher incidence of new conduction disorders in terms of long-term survival.…”

“…cardiac biomarker rise) after TAVI is frequent and may predict the outcome. [3][4][5][6] The exact patho-mechanism of myocardial injury is not clear yet, however several studies hypothesize that factors such as global myocardial ischemia due to balloon valvuloplasty, acute aortic regurgitation, rapid pacing-induced hypotension, micro-embolization of aortic valve debris in the coronary arteries, myocardial tissue compression by the expansion of the device and coronary obstruction should be considered as potential mechanisms for myocardial injury. 3,[7][8][9][10] We hypothesize that prosthesis expansion mechanism may also affect the occurrence of myocardial injury.…”

Intrepid steps towards clinical prime time

“…The high rates of refractory heart failure could be potentially explained by two mechanisms. First, the use of transapical access is associated with myocardial injury and poor outcomes in patients undergoing transapical TAVR (12,13). This effect is likely amplified in patients undergoing TMVR who often have reduced systolic function and in which a higher system profile is used when compared to transapical TAVR (32-to 40-vs. 18-Fr) (9).…”