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).
Cohort (n=898)
No
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?
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.
Absolute Event Rate: 62.4% vs 56.1%
p-value: p=0.07
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).
Waldschmidt et al. (Sat,) conducted a cohort in Severe aortic stenosis (n=898). Self-expanding transcatheter heart valve (SEV) vs. Balloon-expandable transcatheter heart valve (BEV) was evaluated on Periprocedural myocardial injury according to the 4th universal definition of myocardial infarction (UDMI) (p=0.07). 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).
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