title: Myocardial Injury After Transaortic Versus Transapical Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  The release of cardiac biomarkers of myocardial injury after transcatheter aortic valve replacement (TAVR) is common, but no data exist on patients undergoing TAVR through a transaortic approach. We aimed to evaluate the incidence and prognostic significance of the increase in cardiac biomarkers in nontransfemoral TAVR candidates, comparing transaortic and transapical approaches.
  
  
  METHODS
  After excluding patients deemed suitable for transfemoral TAVR, 251 consecutive patients (transaortic, 45; transapical, 206) were prospectively evaluated. Creatine kinase-myocardial band and cardiac troponin T levels were measured at baseline and at 6, 12, 24, 48, and 72 hours after TAVR. Baseline and 6- to 12-month echocardiographic and clinical follow-up were performed.
  
  
  RESULTS
  After TAVR, cardiac troponin T increased above the upper normal values in all patients (peak value 0.64 μg/L [IQR, 0.39 to 1.03 μg/L]), whereas creatine kinase-myocardial band levels increased in 88% of patients (transaortic 51%, transapical 96%, p < 0.001; peak value 20.1 μg/L [interquartile range, 14.3 to 31.6 μg/L]). Compared with the transaortic approach, the transapical approach was associated with a greater rise in both cardiac biomarkers (p < 0.001 for both), and a lesser improvement in left ventricular ejection fraction (p = 0.058) and global longitudinal strain (p = 0.039) at 6- to 12-month follow-up. Greater increases of cardiac troponin T levels were independently associated with 30-day and 1-year overall and cardiovascular mortality (p < 0.001 for all). A 15-fold rise in cardiac troponin T levels was the optimal threshold for determining poorer outcomes (p < 0.001).
  
  
  CONCLUSIONS
  Periprocedural TAVR-related myocardial injury in nontransfemoral candidates was demonstrated in all patients, but the transapical approach was associated with significantly greater myocardial injury compared with the transaortic approach. A higher degree of myocardial injury translated into reduced left ventricular function improvement and lower early and midterm survival rates.
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Henrique B
authors: HB
authors: Ribeiro
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Abdellaziz
authors: A
authors: Dahou
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Marina
authors: M
authors: Urena
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Jose Luis
authors: JL
authors: Carrasco
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Siamak
authors: S
authors: Mohammadi
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Daniel
authors: D
authors: Doyle
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Florent
authors: F
authors: Le Ven
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Ricardo
authors: R
authors: Allende
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Ignacio
authors: I
authors: Amat-Santos
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Jean-Michel
authors: JM
authors: Paradis
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Robert
authors: R
authors: DeLarochellière
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Rishi
authors: R
authors: Puri
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Omar
authors: O
authors: Abdul-Jawad Altisent
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Maria
authors: M
authors: del Trigo
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Francisco
authors: F
authors: Campelo-Parada
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Philippe
authors: P
authors: Pibarot
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Éric
authors: É
authors: Dumont
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D009206:Myocardium / Q000378:metabolism*; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin; D003402:Creatine Kinase