Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 25:S0003-4975(25)00164-X.
doi: 10.1016/j.athoracsur.2025.01.035. Online ahead of print.

Apical Access Management in Transapical Transcatheter Mitral Valve Replacement

Tillmann Kerbel  1 , Mirjam G Wild  2 , Michaela M Hell  3 , Harald Herkner  4 , Liliane Zillner  1 , Elmar W Kuhn  5 , Tanja Rudolph  6 , Thomas Walther  7 , Lenard Conradi  8 , Andreas Zierer  9 , Francesco Maisano  10 , Marco Russo  11 , Fabrizio Rosati  12 , Andrea Colli  13 , Miguel Piñón  14 , David Reineke  15 , Gaby Aphram  16 , Christophe Dubois  17 , Jörg Hausleiter  18 , Ralph Stephan von Bardeleben  3 , Martin Andreas  19 ; TENDER investigators
Collaborators, Affiliations
Free article

Apical Access Management in Transapical Transcatheter Mitral Valve Replacement

Tillmann Kerbel et al. Ann Thorac Surg. .
Free article

Abstract

Background: The role of the surgical technique and anatomy in transapical mitral valve replacement are scarcely investigated.

Methods: Computed tomography scans, surgical reports and planning slides of 127 patients undergoing transapical mitral valve replacement with the Tendyne valve system (Abbott Vascular) at 15 centers, participating in a European observational study, were retrospectively analyzed and compared between patients with (cohort A) and without (cohort B) apical access complications (AACs).

Results: A total of 8 (6.3%) AACs were recorded, of which 7 of 8 were observed in the first 10 patients of the respective center. Patients with AACs showed a trend to a thinner myocardium at the target access compared with those with regular access (median 4.4 vs 6.1 mm, P = .086). Technical difficulties along with AACs were reflected by a significant longer procedural time (median 180 vs 123 min, P = .011), higher rates of circulation support (50% vs 0%, P < .001), valve retrieval (38% vs 3%, P = .005), and bailout full sternotomy (13% vs 0%, P = .063). AACs were related with an intraprocedural mortality and in-hospital mortality rate of 25% (vs 0%, P = .010) and 50% (vs 7%, P = .003), respectively. In total, 8 of 12 in-hospital deaths were attributed to AACs and/or sepsis. AACs significantly increased the risk for 30-day (adjusted odds ratio, 19.5; 95% CI, 2.19-178.3; P = .008) and in-hospital mortality (adjusted hazard ratio, 9.00; 95% CI, 1.95-41.42; P = .005).

Conclusions: Access complications in transapical mitral valve replacement 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 AACs and improve outcome.

PubMed Disclaimer

Conflict of interest statement

Disclosures Dr Kerbel received speaker honoraria from Abbott. Dr Kuhn declares following conflicts of interests: Medtronic, Abbott (proctoring). Dr Conradi reports to serve as an advisory board member for Abbott, Medtronic, JenaValve, consultant for Edwards Lifesciences, BostonScientific, MicroPort, PiCardia, VenusMedtech, Neovasc, MicroInterventions, and Smartcanula sarl. Dr Zierer serves as a proctor (Tendyne) and received speaker fees and educational grants from Abbott. Dr Maisano reports grant and/or research institutional support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, Terumo, Venus and consulting fees, honoraria personal and institutional from Abbott, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve, Occlufit, Simulands, Mtex, Venus, Squadra. Royalty Income/IP Rights Edwards Lifesciences Shareholder (including share options) of Cardiogard, Cardiovalve, Magenta, SwissVortex, Transseptalsolutions, 4Tech, Perifect. Dr Russo received research support from Edwards Lifescience. Dr Colli is proctor/consultant for Abbott. Dr Reineke reports travel expenses from Abbott, Edwards Lifesciences and Medtronic and has proctor and consulting contracts with Abbott and Medtronic. Dr Dubois names consultative activities with Boston Scientific and Corcym, and proctoring for Edwards Lifescience as potential conflicts. Dr Hausleiter received speaker fees, research support, and advisory fees from Edwards Lifesciences. Dr von Bardeleben serves as a speaker and received advisory fees from Abbott Cardiovascular, Edwards Lifesciences, Medtronic, NeoChord, Philips and Siemens. Further, he reports unpaid trial activity from Abbott Cardiovascular, Edwards Lifesciences, Jenscare, Medtronic and NeoChord. Dr Andreas is proctor/consultant/speaker (Edwards, Abbott, Medtronic, Boston, Zoll, Braun) and received institutional research grants (Edwards, Abbott, Medtronic, LSI). The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

LinkOut - more resources