Courtesy of Dr. Carlos Fava.

Surgical aortic valve replacement (SAVR) continues to be elective, but the presence of post-procedural acute myocardial infarction (AMI) has been associated to bad evolution. Despite the proven benefits of TAVR for high risk patients and the progress shown by patients of intermediate risk, the incidence of post implantation MI has not yet been properly assessed and the appropriate course of action to treat coronary artery disease (CAD) patients continues to be a matter of debate.

For this study, 57 TAVR patients and 39 SAVR patients were analyzed. All patients received cardiovascular magnetic resonance (CRI) prior procedure and at 6 months after procedure.

Those undergoing TAVR were older (80 vs. 72 p=<0.001), were a lower functional class (2.6 vs. 3.1 p0<0.001), presented higher EuroSCORE II (1.28 vs. 4.48 p=<0.001) and higher prior cardiovascular surgery rate (32% vs. 3%).

The presence of CAD >50% was observed in 34 patients undergoing TAVR. Only one patient received PCI and TAVR simultaneously. In patients undergoing SAVR, CMR was accompanied in 16 cases (41%).

TAVR was mostly femoral. 45 patients used CoreValve and 12 Lotus. In the SAVR group, most patients received biological valves.

The CMR with late gadolinium enhancement (LGE) showed a small MI with no change in ejection fraction in both groups.

Post procedural MI rate in patients undergoing TAVR that presented CAD was 9% (3 patients).

Conclusion

AMI is not a frequent complication after TAVR and it is more common after SAVR. Infarct mass was small in both groups. Low post procedural MI rate after TAVR, especially with a high number of non-revascularized CAD patients, support prior research suggesting coronary revascularization might be unnecessary.

Comment

This is the first analyzis to compare periprocedural MI with both strategies.

Even though the TAVR group had older patients, with more comorbidities, MI rate resulted far lower in these patients.

This study also showed that the presence of CAD >50% in the TAVR group was not significantly associated with periprocedural MI and that both groups showed similar small MI, with no effect on ventricular function.

The discussion over the best strategy for CAD patients remains open, which still calls for further research.

Courtesy of Dr. Carlos Fava.

Original Title: Post-procedural myocardial infarction following surgical aortic valve replacement and transcatheter aortic valve implantation.

Reference: Laura Dobson EuroIntervention 2017;13:e153-e160.

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