title: Post-procedural myocardial infarction following surgical aortic valve replacement and transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Myocardial injury assessed using cardiac biomarker release is ubiquitous following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), preventing accurate discrimination between focal myocardial infarction (MI) and global injury. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging was used to compare rates of new MI following SAVR and TAVI.
  
  
  RESULTS
  Identical CMR scans were obtained at baseline and six months post procedure in ninety-six patients undergoing SAVR (n=39) and TAVI (n=57). The rate of new MI was greater following SAVR than TAVI (SAVR, n=10 [26%] vs. TAVI, n=3 [5%], p=0.004). Infarct mass was similar between groups (SAVR 1.1±0.6 vs. TAVI 2.0±1.4 g, p=0.395). New MI did not impact on change in LV ejection fraction (SAVR:LGE[+]2.2±4.7 vs. LGE[-]0.9±8.0%, p=0.437, TAVI:LGE[+]-0.9±6.0 vs. LGE[-]2.0±7.8%, p=0.420). Thirty-four patients (60%) in the TAVI group had non-revascularised coronary artery disease (CAD) at the time of TAVI, of whom three (9%) had new MI.
  
  
  CONCLUSIONS
  MI is an infrequent complication of TAVI but is more common following SAVR. Infarct size is small following both procedures. The low new infarct rate in TAVI, especially in the context of high rates of non-revascularised CAD, strengthens data from previous studies suggesting that coronary revascularisation pre-TAVI may be unnecessary.
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, United Kingdom.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dobson
authors.forename: Tarique A
authors.initials: TA
authors.lastname: Musa
authors.forename: Akhlaque
authors.initials: A
authors.lastname: Uddin
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Fairbairn
authors.forename: Peter P
authors.initials: PP
authors.lastname: Swoboda
authors.forename: David P
authors.initials: DP
authors.lastname: Ripley
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.forename: Betsy
authors.initials: B
authors.lastname: Evans
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Malkin
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media