- Poster presentation
- Open Access
Post-procedural myocardial infarction following surgical and trans-catheter aortic valve replacement - mechanistic insights from cardiovascular magnetic resonance imaging
© Dobson et al. 2016
- Published: 27 January 2016
- Coronary Artery Bypass Grafting
- Cardiovascular Magnetic Resonance
- Late Gadolinium Enhancement
- Transcatheter Aortic Valve Replacement
- Late Gadolinium Enhancement Imaging
Cardiac biomarker release is ubiquitous following surgical and transcatheter aortic valve replacement (SAVR and TAVR), preventing accurate discrimination between release due to focal myocardial infarction (MI) and global myocardial injury. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement imaging (LGE) is the most sensitive imaging method to detect post-procedural new MI. Our study aimed to compare rates of new MI using CMR LGE before and 6m after TAVR and SAVR.
Ninety six patients with severe aortic stenosis undergoing TAVR (n = 57) and SAVR (n = 39) were prospectively recruited and scanned prior to (median 1 day) and 6 months following valve intervention. The presence of significant coronary artery disease (CAD) was determined by the occurrence of a >50% stenosis in any major epicardial vessel. Areas of LGE were quantified with computer-assisted planimetry (2SD; cmr42 ,Circle CVI). Presence of new LGE was determined by direct comparison of pre and post-procedure scans.
MI is an infrequent complication of TAVR but is more common following SAVR. Infarct size is small following both procedures. The mechanism is likely to be embolization of valve debris and/or clot. The low new infarct rate in TAVR, especially in the context of high rates of non-revascularized CAD, is reassuring and strengthens the notion that coronary revascularization prior to TAVR may be unnecessary.
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/4.0), 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.