XXXX After Transaortic Versus  Transapical Transcatheter Aortic Valve  Replacement.

@entity1 @entity908 @entity296 @entity6475
BACKGROUND: The release of cardiac biomarkers of @entity296 after transcatheter aortic valve replacement (TAVR) is common, but no data exist on @entity1 undergoing TAVR through a transaortic approach. We aimed to evaluate the incidence and prognostic significance of the increase in cardiac biomarkers in nontransfemoral TAVR candidates, comparing transaortic and transapical approaches. METHODS: After excluding @entity1 deemed suitable for transfemoral TAVR, 251 consecutive @entity1 (transaortic, 45; transapical, 206) were prospectively evaluated. @entity908 kinase-myocardial band and cardiac troponin T levels were measured at baseline and at 6, 12, 24, 48, and 72 hours after TAVR. Baseline and 6- to 12-month echocardiographic and clinical follow-up were performed. RESULTS: After TAVR, cardiac troponin T increased above the upper normal values in all @entity1 (peak value 0.64  g/L [IQR, 0.39 to 1.03  g/L]), whereas @entity908 kinase-myocardial band levels increased in 88% of @entity1 (transaortic 51%, transapical 96%, p < 0.001; peak value 20.1   g/L [interquartile range, 14.3 to 31.6  g/L]). Compared with the transaortic approach, the transapical approach was associated with a greater rise in both cardiac biomarkers (p < 0.001 for both), and a lesser improvement in left ventricular ejection fraction (p  = 0.058) and @entity6475 (p  = 0.039) at 6- to 12-month follow-up. Greater increases of cardiac troponin T levels were independently associated with 30-day and 1-year overall and cardiovascular mortality (p < 0.001 for all). A 15-fold rise in cardiac troponin T levels was the optimal threshold for determining poorer outcomes (p < 0.001). CONCLUSIONS: Periprocedural TAVR-related @entity296 in nontransfemoral candidates was demonstrated in all @entity1 , but the transapical approach was associated with significantly greater @entity296 compared with the transaortic approach. A higher degree of @entity296 translated into reduced left ventricular function improvement and lower early and midterm survival rates.
