Myocardial Injury Post Transcatheter Aortic Valve Implantation Comparing Mechanically Expanded Versus Self-Expandable Versus Balloon Expandable Valves

<b>Background</b>: Myocardial injury is common with transcatheter aortic valve implantation (TAVI) and may predict poor outcome. We aim 1) to evaluate the difference in change of high sensitive Troponin T (hsTnT) within 24 hours after transfemoral-TAVI between mechanically-expanded (MEV), self-expanding (SEV) and balloon-expandable (BEV) valves, 2) to determine predictors for myocardial injury post-TAVI and 3) to assess whether myocardial injury is associated with 30-day mortality. <b>Methods</b>: This multicenter retrospective observational study included 1208 consecutively treated transfemoral-TAVI patients from three European centers. All patients treated with a MEV, SEV or BEV with available hsTnT measurements at baseline and within 24 hours post-TAVI were included. Significant myocardial injury was defined as an elevation of hsTnT exceeding ≥ 15x the upper reference limit . <b>Results</b>: Overall, the median hsTnT rise was 741 ng/L and was lower with MEV than with SEV or BEV (MEV 335 vs. SEV 901 vs. BEV 649 ng/L, p&lt;0.001). Myocardial injury occurred in 925 patients (77%) and was less frequent with MEV (MEV 67%, SEV 79% and BEV 76%, p=0.007). Occurrence of myocardial injury was similar after implantation of first vs. second generation SEV (79 vs. 80%, p=0.72) and BEV (77 vs. 76%, p=0.90). There was no association between frequency of annulus manipulation and myocardial injury. On multivariate analysis (OR (95%CI) non-MEV (1.63 (1.06-2.49), p=0.025), mean aortic gradient (1.02 (1.01-1.03), p&lt;0.001), left ventricular ejection fraction (1.03 (1.01-1.04), p&lt;0.001), and previous myocardial infarction (1.62 (1.04-2.56), p=0.032) were positively associated with myocardial injury. There was no association between myocardial injury and 30-day mortality. <b>Conclusion</b>: Transcatheter valve design determines peri-procedural myocardial injury and is less frequent with MEV. Myocardial injury is not associated with 30-day mortality.