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Apical Access Management in Transapical Transcatheter Mitral Valve Replacement.

Tillmann Kerbel1, Mirjam G Wild2, Michaela M Hell3

  • 1Department of Cardiac Surgery, Medical University of Vienna, Austria.

The Annals of Thoracic Surgery
|February 27, 2025
PubMed
Summary
This summary is machine-generated.

Access complications during transapical mitral valve replacement are rare but linked to poor outcomes. Careful patient selection and surgical training can help prevent these complications.

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Area of Science:

  • Cardiovascular Surgery
  • Medical Devices
  • Anatomical Studies

Background:

  • The surgical technique and patient anatomy in transapical mitral valve replacement (tMVR) are not well understood.
  • Few studies have investigated the factors contributing to complications in tMVR.

Purpose of the Study:

  • To investigate the role of surgical technique and anatomy in transapical mitral valve replacement.
  • To identify risk factors for apical access complications (AACs) in tMVR.

Main Methods:

  • Retrospective analysis of computed tomography scans, surgical reports, and planning slides from 127 patients undergoing tMVR with the Tendyne valve system.
  • Comparison of patients with and without AACs across 15 European centers.

Main Results:

  • Eight (6.3%) AACs were recorded, primarily in early cases at each center.
  • Patients with AACs had thinner apical myocardium and longer procedure times, requiring more circulatory support and valve retrieval.
  • AACs were significantly associated with increased intraprocedural, in-hospital, and 30-day mortality.

Conclusions:

  • Apical access complications in tMVR are infrequent but carry a high risk of adverse short-term outcomes.
  • Thorough screening of apical myocardium and specialized surgical training may reduce AACs and improve patient outcomes.