Document Detail


Apical-access-related complications associated with trans-catheter aortic valve implantation.
MedLine Citation:
PMID:  21242089     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: The left-ventricular trans-apical access has become well established for trans-catheter aortic valve implantation, especially for patients in whom a retrograde trans-arterial implantation is contraindicated. We report on the short- and long-term implications of the apical-access-site-specific complications. Methods: Between June 2007 and August 2010, 143 patients were scheduled for trans-apical aortic valve implantation (mean age 80±6 years, n=116 females, mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) 21±13%). The patients are followed up at 30 days, 6 months, and then annually. Results: Severe apical bleeding complications occurred in 10 patients (7%). In three of these patients, the procedure was terminated, and no valve was implanted. In the remaining, the bleeding was controlled with cardiopulmonary bypass support (n=3), via median sternotomy (n=1), or both (n=1)±later re-exploration. Two additional patients required postprocedural re-exploration for apical bleeding. An apical pseudo-aneurysm developed in two patients (2%), one of whom was treated by surgical revision. Survival was significantly impaired when either apical bleeding, aneurysm, or re-exploration occurred (75%±0.082 survival at 30 days and 59%±0.122 at 1 year vs 94%±0.023 and 80%±0.043 in patients without apical complications, p=0.012). Twelve patients (8%) experienced secondary wound healing. An apical hypo- or akinesia was detected in 18/54 (33%) patients at 6 months' echocardiographic investigation, and in 11/30 (37%) 1 year after the procedure. Conclusions: The trans-apical access for trans-catheter aortic valve implantation might be challenging in elderly patients with fragile tissue. Severe bleeding complications or aneurysm formation significantly impairs survival. The clinical impact of subsequent apical hypo- or akinesia has to be further followed up.
Authors:
Sabine Bleiziffer; Nicolo Piazza; Domenico Mazzitelli; Anke Opitz; Robert Bauernschmitt; Rüdiger Lange
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-15
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Clinic for Cardiovascular Surgery, German Heart Center Munich, Lazarettstr. 36, 80636 Munich, Germany.
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