title: CMR assessment after a transapical-transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To describe the time course of myocardial scarring after transapical-transcatheter aortic valve implantation (TA-TAVI) with the Edwards SAPIEN XT™ and the Edwards SAPIEN™ prosthesis in a 3-month follow-up study using cardiac magnetic resonance imaging (CMR).
  
  
  METHODS
  In 20 TA-TAVI patients, CMR was performed at discharge and 3 months (3M). Cine-MRI was used for left ventricular (LV) functional assessment, and late gadolinium enhancement (LGE) imaging was employed for detecting the presence of myocardial scarring. Special attention was given to any artifacts caused by the prosthesis, which were consequently defined using a three-grade artifact scale.
  
  
  RESULTS
  We systematically reported the presence of small LGE hyperintensity relating to the apical segment, with no variation found between discharge and 3M (2.8±1.6g vs. 2.35±1.1g). LV ejection fraction, end-diastolic, and end-systolic volumes did not significantly vary. A small area of apical akinesia was observed, with no improvement at follow-up. Whereas the Edwards SAPIEN XT™ prosthesis and the Edwards SAPIEN™ prosthesis are both constituted by metallic stenting structure, the Edwards SAPIEN™ was responsible for a larger signal void, thus potentially limiting the diagnostic performance of CMR.
  
  
  CONCLUSIONS
  CMR may be performed safely in the context of TA-TAVI. The presence of a very small apical infarction correlating with focal akinesia was observed. As expected, the Edwards SAPIEN XT™ prosthesis was shown to be particularly suitable for CMR assessment.
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France. Electronic address: lobiere@chu-angers.fr.
authors: Loïc
authors: L
authors: Biere
authors: L'UNAM Université, Angers, France; Université d'Angers, CHU d'Angers, Service de Chirurgie Cardio-vasculaire et Thoracique, Angers, France; UMR-CNRS 6214, INSERM 1083, faculté de médecine, Angers, France.
authors: Frédéric
authors: F
authors: Pinaud
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France.
authors: Stéphane
authors: S
authors: Delépine
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France.
authors: Sylvain
authors: S
authors: Grall
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France.
authors: Nathalie
authors: N
authors: Viot
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France.
authors: Victor
authors: V
authors: Mateus
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France.
authors: Frédéric
authors: F
authors: Rouleau
authors: Université d'Angers, CHU d'Angers, Département d'anesthésie-réanimation, Angers, France.
authors: Jean-Jacques
authors: JJ
authors: Corbeau
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France.
authors: Fabrice
authors: F
authors: Prunier
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France; Université d'Angers, CHU d'Angers, Service de Chirurgie Cardio-vasculaire et Thoracique, Angers, France.
authors: Jean-Louis
authors: JL
authors: De Brux
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France; Université d'Angers, CHU d'Angers, Service de Radiologie, Angers, France.
authors: Serge
authors: S
authors: Willoteaux
authors: L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France.
authors: Alain
authors: A
authors: Furber
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery; D016477:Artifacts; D002921:Cicatrix / Q000209:etiology* / Q000473:pathology*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: CMR; Cardiac magnetic resonance imaging; LGE; LV; Late gadolinium enhancement; Myocardial scar; TA; TAVI; TF; Trans-apical TAVI; cardiac magnetic resonance imaging; late gadolinium enhancement; left ventricle; transapical; transcatheter aortic valve implantation; transfemoral