New Research PaperStructuralMyocardial Injury After Transcatheter Aortic Valve Replacement According to VARC-3 Criteria
Central Illustration
Section snippets
Methods
The study included consecutive patients who underwent a transarterial TAVR procedure with a newer-generation transcatheter valve in 2 tertiary University centers in Canada and Italy, from 2015 to 2022, when the high-sensitivity troponin assay became available in both centers. Exclusion criteria for the study included procedural death, patients receiving a first-generation transcatheter valve (Edwards SAPIEN [Edwards Lifesciences], Edwards SAPIEN XT [Edwards Lifesciences], CoreValve [Medtronic],
Results
A total of 1,721 consecutive patients underwent TAVR since the implementation of high-sensitivity troponin in both centers. Of these, 98 patients were excluded for meeting the exclusion criteria and 229 were excluded for not having troponin analysis obtained within 24 hours post-TAVR (Figure 1) (Supplemental Table 1). Therefore, the final study population consisted of 1,394 patients. The mean age of the population was 79.5 ± 7.5 years, with 46.4% women, and a mean EuroSCORE (European System for
Discussion
For the first time, the results of this study revealed that about 1 out of 10 patients undergoing transarterial TAVR in the contemporary era had PPMI according to VARC-3 criteria, which was a much lower rate as compared with the occurrence of PPMI according to VARC-2 criteria. Baseline characteristics such as female sex and peripheral artery disease were independently associated with PPMI post-TAVR. The occurrence of PPMI according to VARC-3 definition was associated with an increased risk of
Conclusions
PPMI as defined by recent VARC-3 criteria occurred in about 1 out of 10 patients undergoing TAVR in the contemporary era. In addition to baseline patient characteristics (female sex, peripheral artery disease), the use of balloon pre- and postdilation during TAVR tended to increase the risk of PPMI, suggesting that any additional intervention during the procedure may have an impact on cardiac troponin release. This would invite to further evaluate the risks and benefits of each additional
Funding Support and Author Disclosures
Dr Real was funded by the Fundación Interhospitalaria para la Investigación Cardiovascular. Dr Nuche was the recipient of a grant from the Fundación Alfonso Martín Escudero (Madrid, Spain). Dr Rodés-Cabau has received institutional research grants and speaker/consultant fees from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Acknowledgments
Dr Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions (Laval University). Amaya De Cos-Gandoy provided statistical advice.
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