https://doi.org/10.1007/s00392-025-02625-4
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland
Background:
Periprocedural myocardial injury during transcatheter aortic valve implantation (TAVI) is associated with impaired short- and longterm outcomes. The impact of transcatheter heart valve (THV) design in terms of valve position on myocardial injury is unclear. While supraannular resheathable THV (Medtronic Evolut) cause low-flow during implantation, intra-annular resheathable THV (Abbott Navitor) are fully functional during the whole implantation cycle without relevant low-flow periods, frequently resulting in more stable hemodynamics during implantation. Whether this difference translates to less periprocedural myocardial injury is subject of the following analysis.
Methods:
216 patients with severe aortic stenosis treated with transfemoral TAVI using Evolut Pro/Pro+(N=151,study group) or Navitor (N=65, control group) between 2021 and 2023 were included. High-sensitvity cardiac troponin I (hs-cTnI; Siemens Atellica IM high-sensitivity troponin I) was measured preoperative and between 2nd and 5th postprocedural day. Groups were compared using the Kuskal-Wallis test for continuous and the Chi Square test for binary variables. Values are median [interquartile range (IQR)] unless otherwise indicated.
Results:
Baseline characteristics of both groups were similar: no differences were found regarding age (study group: 83.0 [79.2, 86.0] vs. control group: 82.9 [80.1, 85.6] years ;p=0.99) LV-function (LVEF ≥ 55%: 61.6% vs 57.1%, p=0.62), extent of coronary artery disease (≥2-vessel disease: 48.2% vs 47.1%, p=0.95), glomerular filtration rate (59.6 [46.9, 76.0] vs. 59.2 [43.1, 74.2] ml/min) and STS Score (2.7 [1.8, 4.0] vs 2.6 [2.0, 4.4], p=0.76).
Median baseline hs-cTnI values were 19.5 [11.9, 48.1] ng/L in the study group and 14.0 [7.7, 47.0] ng/L in the control group (p= 0.18). TAVI procedures in the control group were shorter (procedure time: 55.0 [40.0, 81.7] vs. 69.0 [55.0, 97.0] min, p<0.001), showed lower fluoroscopy utilization (13.9 [9.5, 18.2] vs. 16.4 [12.2, 20.3] min, p=0.003) and lower use of contrast agent (143.0 [118.8, 169.1] vs. 159.0 [130.0, 198.3] ml, p=0.01). Hemodynamic and clinical outcomes at 30 days were similar between groups.
The extend of periprocedural myocardial injury tended to be higher in supra-annular THV compared to intra-annular THV without reaching significance: Median postoperative hs-cTnI was 311.0 [196.0, 586.2] ng/L in the study group and 293.0 [141.0, 520.7] ng/L in the control group (p=0.26). Comparing hs-cTnI levels at different postoperative days showed a similar result (Figure 1).
Conclusion:
Overall, both THV platforms showed excellent performance and relevant periprocedural myocardial injury was rare. There were no significant differences in the extent of myocardial injury comparing supra- and intrannular THV designs.