Percutaneous Transapical Left Ventricular Access to Treat Paravalvular Leak and Ventricular Septal Defect.
Aged
Aged, 80 and over
Cardiac Catheterization
/ methods
Cardiac Surgical Procedures
/ methods
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Female
Fluoroscopy
Follow-Up Studies
Heart Septal Defects, Ventricular
/ diagnosis
Heart Ventricles
/ diagnostic imaging
Humans
Male
Middle Aged
Retrospective Studies
Septal Occluder Device
Survival Rate
/ trends
Treatment Outcome
United States
/ epidemiology
paravalvular leak
vascular closure
ventricular septal defect
Journal
The Journal of invasive cardiology
ISSN: 1557-2501
Titre abrégé: J Invasive Cardiol
Pays: United States
ID NLM: 8917477
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
pubmed:
15
6
2019
medline:
18
2
2020
entrez:
15
6
2019
Statut:
ppublish
Résumé
Surgical transapical (TA) access is an established technique for structural heart (SH) procedures, but is associated with considerable morbidity. Percutaneous TA puncture provides direct access for SH procedures and may overcome the disadvantages of surgical access. This study sought to evaluate the safety of percutaneous TA left ventricular access for SH interventions. We performed a retrospective analysis at a university hospital. Thirteen percutaneous TA procedures were performed on consecutive patients between January 2013 and July 2017 to provide LV access for transcatheter therapies. All procedures were performed under general anesthesia with three-dimensional transesophageal echocardiography guidance. All TA punctures were successful. Delivery sheath sizes ranged from 5 Fr to 7 Fr. Eleven of the 13 TA sites were closed with a device. Total median procedural and fluoroscopy times were 106 minutes (interquartile range, 39-117 minutes) and 26.5 minutes (interquartile range, 8.3-43.8 minutes), respectively. The planned procedure was completed successfully in all cases. One access-site complication occurred, involving embolism of a duct occluder into the pleural space and extravasation from the apical puncture site. Hemostasis of the apex site was achieved immediately with placement of three vascular plugs from a femoral approach. Two patients died prior to discharge and neither death was related to a procedural complication. There were no significant pericardial effusions. Percutaneous TA access can be achieved safely in most cases to provide access for transcatheter procedures with short procedure times. Device closure of the TA access site is reliable, with a low complication rate and no procedure-related mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Surgical transapical (TA) access is an established technique for structural heart (SH) procedures, but is associated with considerable morbidity. Percutaneous TA puncture provides direct access for SH procedures and may overcome the disadvantages of surgical access. This study sought to evaluate the safety of percutaneous TA left ventricular access for SH interventions.
METHODS
METHODS
We performed a retrospective analysis at a university hospital. Thirteen percutaneous TA procedures were performed on consecutive patients between January 2013 and July 2017 to provide LV access for transcatheter therapies. All procedures were performed under general anesthesia with three-dimensional transesophageal echocardiography guidance.
RESULTS
RESULTS
All TA punctures were successful. Delivery sheath sizes ranged from 5 Fr to 7 Fr. Eleven of the 13 TA sites were closed with a device. Total median procedural and fluoroscopy times were 106 minutes (interquartile range, 39-117 minutes) and 26.5 minutes (interquartile range, 8.3-43.8 minutes), respectively. The planned procedure was completed successfully in all cases. One access-site complication occurred, involving embolism of a duct occluder into the pleural space and extravasation from the apical puncture site. Hemostasis of the apex site was achieved immediately with placement of three vascular plugs from a femoral approach. Two patients died prior to discharge and neither death was related to a procedural complication. There were no significant pericardial effusions.
CONCLUSION
CONCLUSIONS
Percutaneous TA access can be achieved safely in most cases to provide access for transcatheter procedures with short procedure times. Device closure of the TA access site is reliable, with a low complication rate and no procedure-related mortality.
Identifiants
pubmed: 31199350
pii: JIC2019615-3
pmc: PMC7135911
mid: NIHMS1565670
pii:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
247-252Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007381
Pays : United States
Références
J Am Coll Cardiol. 2013 Aug 20;62(8):763
pubmed: 23770050
JACC Cardiovasc Interv. 2017 Oct 9;10(19):1959-1969
pubmed: 28982560
Am J Cardiol. 2018 Jul 15;122(2):302-309
pubmed: 29779588
Thorax. 1956 Sep;11(3):163-71
pubmed: 13371566
J Am Coll Cardiol. 2011 Nov 15;58(21):2210-7
pubmed: 22078427
Catheter Cardiovasc Interv. 2010 Dec 1;76(7):993-7
pubmed: 20928838
Pacing Clin Electrophysiol. 2018 Mar;41(3):334-337
pubmed: 29023787
Interact Cardiovasc Thorac Surg. 2017 May 1;24(5):721-726
pubmed: 28329078
Circulation. 2011 Jun 14;123(23):2736-47
pubmed: 21670242
JACC Cardiovasc Interv. 2011 Aug;4(8):868-74
pubmed: 21851900
Catheter Cardiovasc Interv. 2008 Jun 1;71(7):915-8
pubmed: 18383174
J Thorac Dis. 2015 Sep;7(9):1548-55
pubmed: 26543601
Catheter Cardiovasc Interv. 2009 Jul 1;74(1):137-42
pubmed: 19405156