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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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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
Summary
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.
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.
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