Blunt atrial transseptal puncture using excimer laser in swine.
OBJECTIVE
We describe a new approach that may enhance safety of atrial transseptal puncture using a commercially available laser catheter that is capable of perforation only when energized. We test this approach in swine.


BACKGROUND
Despite wide application, conventional needle transseptal puncture continues to risk inadvertent nontarget perforation and its consequences.


METHODS
We used a commercial excimer laser catheter (0.9-mm Clirpath, Spectranetics). Perforation force was compared in vitro with a conventional Brockenbrough needle. Eight swine underwent laser transseptal puncture under X-ray fluoroscopy steered using a variety of delivery catheters.


RESULTS
The 0.9-mm laser catheter traversed in vitro targets with reduced force compared with a Brockenbrough needle. In vitro, the laser catheter created holes that were 25-30% larger than the Brockenbrough needle. Laser puncture of the atrial septum was successful and accurate in all animals, evidenced by oximetry, pressure, angiography, and necropsy. The laser catheter was steered effectively using a modified Mullins introducer sheath and using two different deflectable guiding catheters. The mean procedure time was 15 +/- 6 min, with an average 3.0 +/- 0.8 sec of laser activation. There were no adverse sequelae after prolonged observation. Necropsy revealed discrete 0.9-mm holes in all septae.


CONCLUSIONS
Laser puncture of the interatrial septum is feasible and safe in swine, using a blunt laser catheter that perforates tissues in a controlled fashion.
Elagha
Abdalla A
AA
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
Kim
Ann H
AH
Kocaturk
Ozgur
O
Lederman
Robert J
RJ
D000818:Animals; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005471:Fluoroscopy; D006325:Heart Atria; D006346:Heart Septum; D054018:Lasers, Excimer; D023421:Models, Animal; D009339:Needles; D011677:Punctures; D015641:Radiography, Interventional / Q000379:methods; D012107:Research Design; D013552:Swine