Ventricular function assessed by MRI after transapical aortic valve implantation: apical trauma or simple and safe access?

J Kempfert; A Van Linden; WK Kim; J Blumenstein; A Rolf; H Möllmann; M Schönburg; C Hamm; T Walther

doi:10.1055/s-0031-1297516

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Thorac Cardiovasc Surg 2012; 60 - V126
DOI: 10.1055/s-0031-1297516

Ventricular function assessed by MRI after transapical aortic valve implantation: apical trauma or simple and safe access?

J Kempfert ¹, A Van Linden ¹, WK Kim ², J Blumenstein ¹, A Rolf ², H Möllmann ², M Schönburg ¹, C Hamm ², T Walther ¹

¹Kerckhoff-Klinik Bad Nauheim, Herzchirurgie, Bad Nauheim, Germany
²Kerckhoff-Klinik Bad Nauheim, Kardiologie, Bad Nauheim, Germany

Congress Abstract

Objectives: Transcatheter aortic valve implantation (TAVI) using the antegrade transapical ventricular access has evolved to a safe and simple alternative approach to transfemoral (TF) valve implantation. The potential impact on left ventricular function after the apical access has not been evaluated yet.

Aim of the prospective study was to access changes in left ventricular ejection fraction (EF) by pre- and postoperative echocardiography (echo) and cardiac MRI-scanning.

Methods: A total of 35 patients scheduled for TAVI underwent pre- and postoperative echocardiography and cardiac MRI-scan. 15 patients received TA-AVI (age: 83±5 years; logistic EuroSCORE 27±13%; STS-Score: 7±4%). The other 20 patients underwent TF-AVI (age: 82±5 years; logistic EuroSCORE 22±9%; STS-Score: 5±4%) and served as the control group. Transapical access was established using routine techniques (left mini-thoracotomy, two apical pledged purse-string sutures).

Results: Baseline EF derived from echo and MRI was comparable between both groups (TA: echo 55.4±8.4%, MRI 55.3±9.4% TF: echo 56.7±13.2%, MRI 54.2±13.2%; p=n.s.). Median time interval between the procedure and postoperative MRI/echo was similar between groups (TA: 7 days, TF: 6 days; p=0.494). Postoperatively echo revealed no significant changes in EF compared to baseline (deltaEF TA: 3±7.5%, p=0.159; deltaEF TF:-0.6±3.8%, p=0.547) and no differences between groups. In all patients receiving TA-AVI, MRI demonstrated small localized areas of late-enhancement. However, apical scars had no impact on ventricular function. Changes in EF between pre- and postoperative MRI showed no significant differences between TF and TA patients (TA deltaEF -4.2±8.6%; TF deltaEF 2.2±13.1%; p=0.113).

Conclusions: Limited apical scaring can be detected by cardiac MRI after transapical access (transmural late-enhancement). However, the ventricular access has no negative impact on postoperative EF compared to TF-AVI patients.