{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T02:05:34Z","timestamp":1780538734963,"version":"3.54.1"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,12,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Myocardial injury is associated with higher mortality after transcatheter aortic valve replacement (TAVR) and might be increased by prior balloon aortic valvuloplasty (BAV). We aimed to evaluate the impact of prior BAV versus direct prosthesis implantation on myocardial injury occurring after (TAVR) with balloon\u2010expandable prostheses.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The DIRECTAVI (Direct Transcatheter Aortic Valve Implantation) trial, an open\u2010label randomized study, demonstrated noninferiority of TAVR without BAV (direct TAVR group) compared with systematic BAV (BAV group) with the Edwards SAPIEN 3 valve. High\u2010sensitivity troponin was assessed before and the day after the procedure. Incidence of myocardial injury after the procedure (high\u2010sensitivity troponin elevation &gt;15\u00d7 the upper reference limit [14\u00a0ng\/L]) was the main end point. Impact of myocardial injury on 1\u2010month adverse events (all\u2010cause mortality, stroke, major bleeding, major vascular complications, transfusion, acute kidney injury, heart failure, pacemaker implantation, and aortic regurgitation) was evaluated. Preprocedure and postprocedure high\u2010sensitivity troponin levels were available in 211 patients. The mean age of patients was 83 years (78\u201387 years), with 129 men (61.1%). Mean postprocedure high\u2010sensitivity troponin was 124.9\u00b181.4\u00a0ng\/L in the direct TAVR group versus 170.4\u00b1127.7\u00a0ng\/L in the BAV group (\n              <jats:italic>P<\/jats:italic>\n              =0.007). Myocardial injury occurred in 42 patients (19.9%), including 13 patients (12.2%) in the direct TAVR group and 29 (27.9%) in the BAV group (\n              <jats:italic>P<\/jats:italic>\n              =0.004). BAV increased by 2.8\u2010fold (95% CI, 1.4\u20135.8) myocardial injury probability. Myocardial injury was associated with 1\u2010month adverse events (\n              <jats:italic>P<\/jats:italic>\n              =0.03).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">BAV increased the incidence and magnitude of myocardial injury after TAVR with new\u2010generation balloon\u2010expandable valves. Myocardial injury was associated with 1\u2010month adverse events. These results argue in favor of direct SAPIEN 3 valve implantation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.Clinicaltrials.gov\">https:\/\/www.Clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02729519.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018405","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T10:00:52Z","timestamp":1607594452000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Myocardial Injury After Balloon Predilatation Versus Direct Transcatheter Aortic Valve Replacement: Insights From the DIRECTAVI Trial"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2957-5655","authenticated-orcid":false,"given":"Mariama","family":"Akodad","sequence":"first","affiliation":[{"name":"Department of Cardiology Montpellier University Hospital Montpellier France"},{"name":"PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5288-9687","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Roubille","sequence":"additional","affiliation":[{"name":"Department of Cardiology Montpellier University Hospital Montpellier France"},{"name":"PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Marin","sequence":"additional","affiliation":[{"name":"Department of Medical Information Montpellier University Hospital Montpellier 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