A. Mantha2, N. Asthana3, G. Vorobiof3, P. Benharash1 1University Of California – Los Angeles,Cardiac Surgery,Los Angeles, CA, USA 2University Of California – Irvine,Orange, CA, USA 3University Of California – Los Angeles,Cardiology,Los Angeles, CA, USA
Introduction: Transcatheter valve replacement (TAVR) is a definitive, minimally invasive treatment for patients with severe stenosis (AS) and has been shown to improve myocardial remodelling. However, it is unclear whether these changes occur in patients who have a history of myocardial infarction. This study sought to evaluate the impact of TAVR in patients who had previously suffered a myocardial infarction and have undergone PCI or CABG.
Methods: A review of our prospectively-maintained institutional Society of Thoracic Surgeons database and Transcatheter valve Registry was performed to identify all patients undergoing TAVR from Jan. 2013- Mar. 2016. Chi-square test and regression were used to evaluate differences in patient demographics, readmission rate and length of stay. Repeated measures analysis of variance was used to compare myocardial strain and function among forty-two patients with speckle data through one-month follow-up.
Results: Of the 172 patients included in the analysis, 62 (36%) had previously experienced a myocardial infarction. 22 (33%) underwent PCI alone, 18 (27%) underwent CABG alone and 9 (13%) underwent both PCI and CABG. Patients who underwent PCI alone had a significantly longer length of stay (7.2 vs 4.4 days, p<0.001) after TAVR and higher proportion of patients readmitted within 30 days (37%, p<0.01). Patients with history of MI had consistently lower magnitudes of strain in the septal (p<0.01), anterior (p<0.02), lateral (p<0.01), and inferior (p<0.01) ventricular walls despite having similar ventricular diameter (p=0.77) and septal thickness (p=0.82). Both cohorts demonstrated significant improvement in global longitudinal strain (-19.0 vs -16.0 in control, -17.1 vs -14.1 in MI, p<0.01) and interaction between history of MI and GLS was not significant.
Conclusion: Patients with history of myocardial infarction benefit similarly from TAVR as control patients with no history of MI despite having poorer pre-operative ventricular contractility. However, management strategy of infarction episode may have differential impact on tissue ischemia leading to increased length of stay and risk of readmission after TAVR.