Myocardial Injury After Transaortic Versus Transapical Transcatheter Aortic Valve Replacement Henrique B. Ribeiro, MD, Abdellaziz Dahou, MD, Marina Urena,

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Myocardial Injury After Transaortic Versus Transapical Transcatheter Aortic Valve Replacement Henrique B. Ribeiro, MD, Abdellaziz Dahou, MD, Marina Urena, MD, Jose Luis Carrasco, MD, Siamak Mohammadi, MD, Daniel Doyle, MD, Florent Le Ven, MD, Ricardo Allende, MD, Ignacio Amat-Santos, MD, Jean-Michel Paradis, MD, Robert DeLarochellière, MD, Rishi Puri, MBBS, PhD, Omar Abdul-Jawad Altisent, MD, Maria del Trigo, MD, Francisco Campelo-Parada, MD, Philippe Pibarot, DVM, PhD, Éric Dumont, MD, Josep Rodés-Cabau, MD The Annals of Thoracic Surgery Volume 99, Issue 6, Pages 2001-2009 (June 2015) DOI: 10.1016/j.athoracsur.2015.01.029 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Changes in serum markers of myocardial injury after transcatheter aortic valve replacement (TAVR). Changes in (A) creatine kinase-myocardial band (CK-MB) and (B) cardiac troponin T levels within the 72 hours after TAVR in all patients, and (C, D) grouped according to the approach, transaortic (TAo [green lines]) and transapical (TA [red lines]). Values are expressed as median (25th to 75th interquartile range). The Annals of Thoracic Surgery 2015 99, 2001-2009DOI: (10.1016/j.athoracsur.2015.01.029) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Degree of increase in (A) creatine kinase-myocardial band (CK-MB) and (B) cardiac troponin T levels after transcatheter aortic valve replacement (TAVR). Cardiac biomarker changes after TAVR are grouped according to the degree of CK-MB and cardiac troponin T increase in all patients (blue bars) and in the transaortic (TAo [green bars]) and transapical (TA [red bars]) approach groups. The Annals of Thoracic Surgery 2015 99, 2001-2009DOI: (10.1016/j.athoracsur.2015.01.029) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Changes in serum markers of myocardial injury after transcatheter aortic valve replacement (TAVR) for the propensity-matched cohort. Changes in (A) creatine kinase-myocardial band (CK-MB) and (B) cardiac troponin T levels within the 72 hours after TAVR in the matched population according to the approach: transapical (TA [red lines]) versus transaortic (TAo [green lines]). Values are expressed as median (25th to 75th interquartile range). The Annals of Thoracic Surgery 2015 99, 2001-2009DOI: (10.1016/j.athoracsur.2015.01.029) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Change (delta [Δ]) in left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) after transcatheter aortic valve replacement (TAVR) according to the approach: transapical (TA [red bars]) versus transaortic (TAo [green bars]). (A) Changes in LVEF and (B) GLS between the baseline and 6- to 12-month echocardiography after TAVR for the overall population and for the propensity-matched cohort (panels C and D, respectively). The Annals of Thoracic Surgery 2015 99, 2001-2009DOI: (10.1016/j.athoracsur.2015.01.029) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Myocardial injury and left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) changes after transcatheter aortic valve replacement (TAVR). Relationship between the maximal increase in cardiac troponin T and (A) changes in LVEF and (B) in GLS after TAVR. The Annals of Thoracic Surgery 2015 99, 2001-2009DOI: (10.1016/j.athoracsur.2015.01.029) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions