title: Impact of transapical aortic valve replacement on apical wall motion.
abstract: BACKGROUND
  Recent reports indicate that the transapical approach for transcatheter aortic valve replacement may be associated with elevated cardiac enzymes, poor recovery of left ventricular function, and poor outcomes. The aim of this study was to evaluate whether transapical access is associated with apical dysfunction and to assess consequences on patient outcomes.
  
  
  METHODS
  In patients undergoing transapical aortic valve replacement, apical regional function was retrospectively assessed using the three standard echocardiographic long-axis views. Patients with abnormal baseline apical motion were excluded. Apical regional wall motion abnormality was assessed on preprocedural (baseline), immediate postprocedural (early [6 ± 2 days]), and late postprocedural (late [95 ± 76 days]) examinations. Apical regional wall motion abnormalities were categorized as normal, hypokinesis, or akinesis.
  
  
  RESULTS
  A total of 58 patients undergoing transapical aortic valve replacement were included in the present analysis. Of those, 16 (28%) developed early apical dysfunction. There were no differences in baseline characteristics between the patients who developed early apical dysfunction and those who did not. Patients who received 26-mm valves were more likely to develop apical dysfunction (40% vs. 69%, P = .05). In total, 50% of patients with apical dysfunction (eight of 16) had complete recovery of apical function but tended to have lower ejection fractions (50% vs. 60%, P = .045) at long-term follow-up. No difference in short-term or long-term mortality was detected in these small patient cohorts.
  
  
  CONCLUSIONS
  Myocardial injury during transapical access resulted in apical dysfunction early after the procedure in 28% of patients. This apical dysfunction was transient in half of the patients and was associated with a decrease in left ventricular function but did not affect mortality.
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Corso
authors.forename: Steven A
authors.initials: SA
authors.lastname: Goldstein
authors.forename: Zuyue
authors.initials: Z
authors.lastname: Wang
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bond
authors.forename: Petros G
authors.initials: PG
authors.lastname: Okubagzi
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology