Impact of Transapical Aortic Valve Replacement on Apical Wall Motion

Barbash, Israel M.; Dvir, Danny; Ben‐Dor, Itsik; Corso, Paul J.; Goldstein, Steven A.; Wang, Zuyue; Bond, Elizabeth; Okubagzi, Petros; Satler, Lowell F.; Pichard, Augusto D.; Waksman, Ron

doi:10.1016/j.echo.2012.11.003

Cited by 39 publications

(28 citation statements)

References 25 publications

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“…Interestingly, in patients undergoing TAVI with a balloon-expandable valve, the degree and extent of cardiac biomarker elevation (also more frequent for the TA approach) have also been associated with less improvement in LVEF at one-year follow-up 1 . Also in accordance with these results, Barbash et al 19 showed the presence of apical wall motion abnormalities in about one third of the patients treated through the TA approach, which translated into a lower LVEF at follow-up. While the poorer outcomes associated with the TA approach have been mainly related to the higher risk profile of the patients treated through this approach (usually patients with inadequate iliofemoral access) 20 , the TA approach was found to be an independent predictor of mortality in two large TAVI studies (FRANCE-2 and the UK TAVI Registry) 21,22 as well as in a recent meta-analysis 23 .…”

Section: Figure 4 Degree and Extent Of Myocardial Necrosis At The Apsupporting

confidence: 66%

Myocardial injury following transcatheter aortic valve implantation: insights from delayed-enhancement cardiovascular magnetic resonance

Ribeiro¹,

Larose²,

Ricapito³

et al. 2015

EuroIntervention

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Aims: The aim of this study was to evaluate the presence, localisation and extent of myocardial injury as determined by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging in patients undergoing transcatheter aortic valve implantation (TAVI). Methods and results:A total of 37 patients, who underwent successful TAVI with a balloon-expandable valve (transapical [TA], n=11; non-TA, n=26), were included. Cardiac biomarker (CK-MB and cTnT) levels were determined at baseline and following TAVI. CMR was performed within a week before and within 30 days following TAVI. Some increase in cardiac biomarkers was detected in 97% of the patients as determined by a rise in cTnT, and in 49% of the patients as determined by a rise in CK-MB. Following TAVI, no new myocardial necrosis defects were observed with the non-TA approach. Nonetheless, all patients who underwent TAVI through the TA approach had new focal myocardial necrosis in the apex, with a median myocardial extent and necrotic mass of 5% [2.0-7.0] and 3.5 g [2.3-4.5], respectively.Conclusions: Although some increase in cardiac biomarkers of myocardial injury was systematically detected following TAVI, new myocardial necrosis as evaluated by CMR was observed only in patients undergoing the procedure through the TA approach, involving ~5% of the myocardium in the apex. KEYWORDS• cardiac biomarkers • cardiac magnetic resonance imaging • late gadolinium enhancement • myocardial injury • transcatheter aortic valve implantation

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Section: Figure 4 Degree and Extent Of Myocardial Necrosis At The Apsupporting

confidence: 66%

Myocardial injury following transcatheter aortic valve implantation: insights from delayed-enhancement cardiovascular magnetic resonance

Ribeiro¹,

Larose²,

Ricapito³

et al. 2015

EuroIntervention

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“…In addition substantial clinical data suggest that transapical approach is associated with worse clinical outcomes that cannot be explained solely by dissimilar patient characteristics (7)(8)(9)(10). Transapical approach can occasionally lead to the impairment of left ventricular apical function (11,12). This deterioration in ventric- Using a smaller and better trackable delivery system § § § *These considerations are based mainly on personal clinical experience and only little on scientific data.…”

Section: Procedural Access: All Roads Lead To Romementioning

confidence: 97%

Transseptal Instead of Transapical Valve Implantation

Dvir¹

2016

JACC: Cardiovascular Interventions

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“…Our data adds to previous experience, indicating the transapical approach to be a safe and effective alternative to the femoral access. However, one has to be aware that the transapical access comes at the price of at least transient regional left ventricular dysfunction in about one-third of patients [7]. There are several technical aspects of the procedure that need to be discussed.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience with the Transapical Access for TEVAR

Mahnken

Irqsusi

Hundt

et al. 2017

Fortschr Röntgenstr

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Background The endovascular approach has become a mainstay in the treatment of aortic aneurysms. While the transfemoral approach is most commonly used, it is often inaccessible due to a vascular pathology, such as occlusion, tortuosity or heavy calcifications. The transapical access provides an alternative approach. The goal of this study is to report the feasibility of the transapical approach for total endovascular repair of thoracic aortic aneurysms (TEVAR). Methods Three patients with thoracic aortic aneurysms with inaccessible femoral arteries underwent TEVAR via the transapical approach. For access, the apex of the left ventricle was exposed by a mini-thoracotomy. After left ventricular puncture, a stiff guidewire was placed through the aortic valve into the descending thoracic aorta. All stent grafts were delivered under fluoroscopic guidance. Results All three procedures were technically successful with complete exclusion of the aneurysm without endoleak. One patient suffered spinal ischemia with subsequent paraplegia on day 4 after the procedure. The same patient died on day 43 after the procedure due to esophageal rupture. The two remaining patients did not present procedure-related problems. Conclusion The transapical access is a feasible and safe alternative to the transfemoral route in selected cases scheduled for TEVAR. Key Points Citation Format

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Impact of Transapical Aortic Valve Replacement on Apical Wall Motion

Cited by 39 publications

References 25 publications

Myocardial injury following transcatheter aortic valve implantation: insights from delayed-enhancement cardiovascular magnetic resonance

Myocardial injury following transcatheter aortic valve implantation: insights from delayed-enhancement cardiovascular magnetic resonance

Transseptal Instead of Transapical Valve Implantation

Initial Experience with the Transapical Access for TEVAR

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