Tillmann Kerbel, Mirjam G Wild, Michaela M Hell, Harald Herkner, Liliane Zillner, Elmar W Kuhn, Tanja Rudolph, Thomas Walther, Lenard Conradi, Andreas Zierer, Francesco Maisano, Marco Russo, Fabrizio Rosati, Andrea Colli, Miguel Piñón, David Reineke, Gaby Aphram, Christophe Dubois, Jörg Hausleiter, Ralph Stephan von Bardeleben, Martin Andreas
{"title":"Apical Access Management in Transapical Transcatheter Mitral Valve Replacement.","authors":"Tillmann Kerbel, Mirjam G Wild, Michaela M Hell, Harald Herkner, Liliane Zillner, Elmar W Kuhn, Tanja Rudolph, Thomas Walther, Lenard Conradi, Andreas Zierer, Francesco Maisano, Marco Russo, Fabrizio Rosati, Andrea Colli, Miguel Piñón, David Reineke, Gaby Aphram, Christophe Dubois, Jörg Hausleiter, Ralph Stephan von Bardeleben, Martin Andreas","doi":"10.1016/j.athoracsur.2025.01.035","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The role of the surgical technique and anatomy in transapical mitral valve replacement (TA-TMVR) are scarcely investigated.</p><p><strong>Methods: </strong>Computed tomography scans, surgical reports and planning slides of 127 patients undergoing TA-TMVR with the Tendyne valve system at 15 centers, participating at a European observational study, were retrospectively analyzed and compared between patients with (cohort A) and without (cohort B) apical access complications (AAC).</p><p><strong>Results: </strong>A total of 8 (6.3%) AAC were recorded, of which 7/8 were observed in the first 10 patients of the respective center. Patients with AAC showed a trend to a thinner myocardium at the target access compared to those with regular access (median 4.4 vs. 6.1mm, p=0.086). Technical difficulties along with AAC were reflected by a significant longer procedural time (median 180 vs. 123min, p=0.011), higher rates of circulation support (50% vs. 0%, p<0.001), valve retrieval (38% vs. 3%, p=0.005) and bailout full sternotomy (13% vs. 0%, p=0.063). AAC were related with an intraprocedural mortality and in-hospital mortality rate of 25% (vs. 0%, p=0.010) and 50% (vs. 7%, p=0.003), respectively. Totally, 8 of 12 in-hospital deaths were attributed to AAC and/or sepsis. AAC significantly increased the risk for 30-day (adjusted OR 19.5, CI 2.19-178.3, p=0.008) and in-hospital mortality (adjusted HR 9.00, CI 1.95-41.42, p=0.005).</p><p><strong>Conclusions: </strong>Access complications in TA-TMVR are relatively rare but associated with poor short-term outcome. Focus on the apical myocardium within the screening process and specific surgical training might avoid AAC and improve outcome.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.athoracsur.2025.01.035","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Apical Access Management in Transapical Transcatheter Mitral Valve Replacement.
Background: The role of the surgical technique and anatomy in transapical mitral valve replacement (TA-TMVR) are scarcely investigated.
Methods: Computed tomography scans, surgical reports and planning slides of 127 patients undergoing TA-TMVR with the Tendyne valve system at 15 centers, participating at a European observational study, were retrospectively analyzed and compared between patients with (cohort A) and without (cohort B) apical access complications (AAC).
Results: A total of 8 (6.3%) AAC were recorded, of which 7/8 were observed in the first 10 patients of the respective center. Patients with AAC showed a trend to a thinner myocardium at the target access compared to those with regular access (median 4.4 vs. 6.1mm, p=0.086). Technical difficulties along with AAC were reflected by a significant longer procedural time (median 180 vs. 123min, p=0.011), higher rates of circulation support (50% vs. 0%, p<0.001), valve retrieval (38% vs. 3%, p=0.005) and bailout full sternotomy (13% vs. 0%, p=0.063). AAC were related with an intraprocedural mortality and in-hospital mortality rate of 25% (vs. 0%, p=0.010) and 50% (vs. 7%, p=0.003), respectively. Totally, 8 of 12 in-hospital deaths were attributed to AAC and/or sepsis. AAC significantly increased the risk for 30-day (adjusted OR 19.5, CI 2.19-178.3, p=0.008) and in-hospital mortality (adjusted HR 9.00, CI 1.95-41.42, p=0.005).
Conclusions: Access complications in TA-TMVR are relatively rare but associated with poor short-term outcome. Focus on the apical myocardium within the screening process and specific surgical training might avoid AAC and improve outcome.
期刊介绍：
The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards.
The Annals of Thoracic Surgery features:
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An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.
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