We enrolled 103 consecutive pts with severe symptomatic aortic stenosis and a high surgical risk who underwent TAVI using the Edwards-Sapien valve. TF TAVI was performed in 74 pts under local anesthesia after surgical cutdown of the femoral artery while the other 29 pts underwent a TA TAVI. For the 2 approaches, the valve was implanted during rapid pacing. Cardiac Troponin I (lower limit of detection: 0.2 ¦Ìg/l, suggested diagnostic value for myocardial infarction: 1.0 ¦Ìg/l) was measured before, 8 hours and 24 hours after TAVI.
Pts undergoing TA TAVI were significantly more often males (69 % vs 45 % , p < 0.05), younger (79 ¡À 8 vs 84 ¡À 6 years, p < 0.01) and had more often previous bypass surgery (48 % vs 23 % , p < 0.03) than TF pts. The proportion of pts with previous myocardial infarction, previous PCI, presence of at least one significant (>50 % ) coronary stenosis at the time of valve implantation, was similar between the TF and TA population. Logistic Euroscore, ejection fraction, creatinin level were similar in the 2 groups. After TAVI, the effective orifice area increased from 0.65 ¡À 0.15 to 1.90 ¡À 0.30 cm2 (p < 0.0001) and the transvalvular mean gradient decreased from 44 ¡À 14 to 9 ¡À 4 mmHg (p < 0.0001). While troponin level was similar at baseline in the TF and TA populations (0.06 ¡À 0.14 ¦Ìg/l TF vs 0.11 ¡À 0.34 ¦Ìg/l TA), peak troponin was very significantly higher after TA TAVI than after TF TAVI (65.20 ¡À 61.06 ¦Ìg/l TA vs 5.23 ¡À 7.94 ¦Ìg/l TF, p < 0.001).
Troponin elevation after TA TAVI is much higher than after TF TAVI. Whether theses differences in the degree of myocardial injury have prognostic value will require further studies.