Introduction
Trans-apical aortic valve replacement (TA-AVR) is typically performed in aortic stenosis patients with poor peripheral vascular access. While TA-AVR procedural outcome is comparable to trans-femoral, recent reports indicate that TA-AVR patients have significantly higher levels of serum cardiac markers of myocardial injury as compared to trans-femoral patients. We sought to evaluate whether this enzyme leak is associated with regional wall motion abnormality (RWMA) at the apical access site and to assess correlation with outcome.
Methods
We retrospectively assessed RWMA specifically in the LV apex by the three standard echocardiographic long axis views in patients undergoing TA-AVR ( n = 37). Apical RWMA was assessed on pre-procedure (Baseline), immediate post- (Early, 6 ± 1 d) and late post-procedure (Late, 124 ± 72 d) exams. RWMA was categorized as normal, hypokinesis, or akinesis. Patients with abnormal baseline apical RWMA were excluded ( n = 9).
Methods
We retrospectively assessed RWMA specifically in the LV apex by the three standard echocardiographic long axis views in patients undergoing TA-AVR ( n = 37). Apical RWMA was assessed on pre-procedure (Baseline), immediate post- (Early, 6 ± 1 d) and late post-procedure (Late, 124 ± 72 d) exams. RWMA was categorized as normal, hypokinesis, or akinesis. Patients with abnormal baseline apical RWMA were excluded ( n = 9).
Results
Among 28 TA-AVR patients, six (21%) had apical RWMA (5/6 had hypokinesis, 1/6 had akinesis). Patients with early hypokinesis of the apex had full recovery in the late follow-up; however the apex did not recover in the single patient with early akinesia. As shown in Table 1 , patients who developed apical RWMA were older (88 ± 6 vs. 84 ± 4 years, P = .05) than patients with normal apical movement. Apart from age, there were no additional differences in baseline characteristic. Post-procedural serum cardiac markers were comparable between the two groups. Apical RWMA was not associated with adverse outcome ( Table 1 ).
