What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=898). Intervention: Self-expanding transcatheter heart valve (SEV) vs. Balloon-expandable transcatheter heart valve (BEV). Primary outcome: Periprocedural myocardial injury according to the 4th universal definition of myocardial infarction (UDMI) (p=0.07).

What does this research mean for the field?

The choice of transcatheter heart valve platform did not significantly impact periprocedural myocardial injury or 1-year all-cause mortality in TAVI patients (HR 0.81, p=0.38). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to investigate the relationship between different types of transcatheter heart valves and the occurrence of myocardial injury during TAVI procedures.

February 6, 2026

Association between transcatheter heart valve type and periprocedural myocardial injury in transcatheter aortic valve implantation

Resultado clave

Self-expanding transcatheter heart valves did not significantly differ from balloon-expandable valves in the incidence of periprocedural myocardial injury (62.4% vs 56.1%; p=0.07).

Puntos clave

This research aims to investigate the relationship between different types of transcatheter heart valves and the occurrence of myocardial injury during TAVI procedures.
Included consecutive patients with severe aortic stenosis undergoing transfemoral TAVI with BEV or SEV.
Measured high-sensitivity cardiac troponin I preoperatively and postoperatively on days 1-5.
Compared outcomes using the Kuskal-Wallis test for continuous variables and Chi Square test for categorical variables.
Assessed 1-year all-cause mortality using Cox proportional hazard ratios.
Out of 898 patients, those receiving BEV were younger and had lower pre-operative risk scores.
Postoperative cardiac troponin levels were higher in SEV patients but not statistically significant.
No significant differences in myocardial injury were found using different classifications between valve types.
Choice of valve platform did not affect 1-year all-cause mortality rates.

Diseño del estudio

Tipo

Cohort (n=898)

Multicéntrico

PICO estructurado

Does the choice of self-expanding versus balloon-expandable transcatheter heart valve affect the incidence of periprocedural myocardial injury or 1-year mortality in patients with severe aortic stenosis undergoing TAVI?

Población

898 consecutive patients with severe aortic stenosis undergoing transfemoral transcatheter aortic valve implantation (TAVI) at a German tertiary center between 2021 and 2023.

Intervención

Self-expanding transcatheter heart valve (SEV) (n=545)

Comparador

Balloon-expandable transcatheter heart valve (BEV) (n=353)

Resultado

Periprocedural myocardial injury (MI) measured by high-sensitivity cardiac troponin I (hs-cTnI) between postprocedural day 1 and 5safety

The choice between self-expanding and balloon-expandable transcatheter heart valves does not significantly impact the incidence of periprocedural myocardial injury or 1-year all-cause mortality in patients undergoing TAVI.

Resultado numérico

Tasa de eventos absoluta: 62.4% vs 56.1%

valor p: p=0.07

Resumen

Abstract Background Periprocedural myocardial injury (MI) during transcatheter aortic valve implantation (TAVI) may be linked to adverse short- and long-term clinical outcome. However, data on the influence of different transcatheter heart valve (THV) platforms on MI incidence remain inconsistent. In particular, a direct comparison of MI occurrence following implantation of modern balloon-expandable (BEV) and self-expanding (SEV) THV-platforms is warranted. Methods All consecutive patients with severe aortic stenosis who underwent transfemoral TAVI with either a BEV or SEV at a German tertiary center between 2021 and 2023 were included. High-sensitivity cardiac troponin I (hs-cTnI; Siemens Atellica IM high-sensitivity troponin I) was measured preoperatively and between the first and fifth postprocedural day. THV-groups were compared using the Kuskal-Wallis test for continuous and the Chi Square test for binary variables. Cox proportional hazard ratios were applied to assess the association between valve type and 1-year all-cause mortality. Results A total of 898 patients undergoing TAVI using BEV (N=353) or SEV (N=545) were included. Patients receiving BEV were younger (79.7 vs 83.2 years, p=0.001), more often male (71.1% vs 50.2%, p=0.001), had a lower pre-operative risk score (STS PROM 2.2% IQR 1.5-3.6 vs 2.9% IQR 2.0-4.6, p=0.001) and better kidney function (eGFR 65.5 vs 68.9 ml/min/1.73 m2, p=0.001). Overall, postoperative hs-cTnI values after TAVI tended to be higher in SEV-treated patients without reaching significance (297.0 ng/L IQR 159.0-577.7 ng/L vs 263.0 ng/L 139.7-581.7 ng/L, p=0.083, Figure 1). Occurrence of MI using different classifications did not show significant differences between both patient groups: MI according to 4th universal definition of myocardial infarction (UDMI; 5-times upper reference limit; URL) was found in 62.4% of SEV vs 56.1% of BEV patients (p=0.07), SCAI criteria (35-times URL) were met in 7.7% of SEV and 5.9% of BEV patients (p=0.38) and MI according to ARC-2 (70-times URL) was present in 1.8% of SEV and 2.3% of BEV patients (p=0.84). Following cox-proportional hazard ratios the choice of valve platform did not affect 1-year all-cause mortality (HR for SEV 0.81 95% CI 0.51-1.29, p=0.38). Conclusion Periprocedural MI according to the 4th UDMI is common among patients with severe AS undergoing TAVI. However, the choice of THV platform did not impact the incidence of MI or all-cause mortality at 1 year. Figure 1: Postprocedural hs-cTnI levels in balloon-expandable and self-expanding THV platforms High-sensitivity cardiac troponin I (hs-cTnI) levels measured between postprocedural day 1 and 5. Boxplots display median, interquartile range (IQR; box), total range (whiskers), and outliers (dots).

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