Volume 16 Supplement 1

Abstracts of the 17th Annual SCMR Scientific Sessions

Open Access

Early effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and injury: insights from Cardiovascular Magnetic Resonance

  • Gareth Crouch1, 2,
  • Jayme Bennetts2,
  • Ajay Sinhal3,
  • Phillip J Tully2,
  • Darryl Leong1,
  • Craig Bradbrook1,
  • Amy Swan3,
  • Jawad Mazhar3,
  • Carmine De Pasquale3, 1,
  • Majo Joseph3,
  • Robert A Baker2 and
  • Joseph Selvanayagam1, 3
Journal of Cardiovascular Magnetic Resonance201416(Suppl 1):P285

https://doi.org/10.1186/1532-429X-16-S1-P285

Published: 16 January 2014

Background

To assess the early effects on myocardial function, reversible and irreversible myocardial injury of both transcatheter (TAVI) and open aortic valve replacement (AVR) utilizing cardiovascular magnetic resonance (CMR) and biochemistry. Although recent studies have reported on clinical outcomes, there has been a paucity of mechanistic data on the effect of TAVI on ventricular function and irreversible myocardial injury.

Methods

We conducted a prospective comparative study of 47 patients (26 TAVI, 21 AVR) with severe aortic stenosis and normal or mildly impaired ventricular function undergoing either TAVI or high risk AVR. CMR (for LV/RV function, LV mass, oedema, irreversible injury, and aortic valve regurgitation) was carried out pre- and early post-operatively ( < 2 weeks). Biochemistry, high-sensitivity troponin and Pro B-type natriuretic peptide, and transthoracic echocardiography were also performed.

Results

Groups were similar with respect to STS Score (TAVI 7.7 vs AVR 5.9 p = 0.11) and comorbidities, however the TAVI group were older (84.6 yrs ± 6 vs 79.6 yrs ± 4, p < 0.001). Preoperative left ventricular (LVEF: TAVI 69% ± 13 vs AVR 73% ± 10 p = 0.10) and right ventricular ejection fractions (RVEF: TAVI 61% ± 11 vs AVR 59% ± 8 p = 0.5) were similar. Post-operative LVEF was preserved in both groups. In contrast, a decline in RVEF was notably more significant in the TAVI group (61% to 54% vs 59% to 58%, p = 0.01). Further analysis showed a trend (p = 0.08) association between the degree of post-procedure aortic regurgitation and RV dysfunction. There were no differences in the rate of reversible (T2)irreversible (LGE) injury.

Conclusions

There was no significant difference in early left ventricular systolic function between open and transcatheter techniques, matched by similar myocardial injury rates. While RV systolic function was preserved in the AVR group, it was significantly impaired early after TAVI, correlating with the degree of para-valvular aortic regurgitation.

Funding

Funding was provided in the form of unencumbered research grants from St Jude Medical and Edwards Lifesciences.

Authors’ Affiliations

(1)
Centre for Cardiovascular Magnetic Resonance Research, Flinders University
(2)
Cardiothoracic Surgery, Flinders Medical Centre
(3)
Cardiovascular Medicine, Flinders Medical Centre

Copyright

© Crouch et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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