Impact of Cardio-anatomical Characteristics on Bleeding Complications of Transapical Transcatheter Intervention

Background: Transapical (TA) access is used for implantation of transcatheter aortic and mitral valves. While aortic valve stenosis is frequently associated with left ventricular (LV) hypertrophy and thick myocardium, mitral valve regurgitation may lead to ventricular dilatation and thinning of the myocardial wall. To anticipate complications at the myocardial access site computed tomography (CT) scans were analyzed regarding LV apical anatomy.

Methods: Patients undergoing TA mitral valve implantation (TA-TMVI, n = 23) were retrospectively compared with patients undergoing TA transcatheter aortic valve implantation (TA-TAVI, n = 23) with respect to postoperative bleeding complications at the access site. Complications at the access site were defined as bleeding events with the need for a surgical revision. Further, pre-procedural CT scans were analyzed with focus on the left ventricular configuration.

Results: Patient cohorts were comparable regarding demographic characteristics and risk preoperative scores. Comparative CT scan analysis for TA-TMVI versus TA-TAVI at the access site (apex) resulted in volume of the intraventricular cavum at the apex (5.1 ± 1.2 cm³ versus 4.2 ± 1.2 cm³; p = 0.010), volume of epicardial fat at the apex (4.2 ± 3.1 cm³ versus 2.5 ± 1.0 cm³; p = 0.009), and volume of myocardial tissue at the apex (8.1 ± 1.9 cm³ versus 10.3 ± 5.8 cm³; p = 0.088). Calculated ratio of intraventricular cavum volume to epicardial fat volume (1.8 ± 0.8 versus 1.5 ± 0.7; p = 0.208) did not differ between TA-MVI and TA-TAVI patients. Ratios of intraventricular cavum volume to myocardial tissue volume (0.7 ± 0.2 versus 0.5 ± 0.2; p = 0.001) and epicardial fat volume to myocardial tissue volume (0.5 ± 0.3 versus 0.2 ± 0.1; p = 0.002) were significantly higher in the TA-TMVI group. Revision rates for bleeding at the access site were 43% versus 26% (p = 0.216) for TA-TMVI versus TA-TAVI patients.

Conclusion: Patients referred for TA-TMVI and TA-TAVI present with different cardio-anatomical characteristics. Volume measurements of the apical access site prior to transcatheter mitral valve implantations may provide important information regarding risk of bleeding complications and may help to guide intraprocedural complication management.

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Artikel online veröffentlicht:
11. Februar 2025