title: Clinical experience with percutaneous left ventricular transapical access for interventions in structural heart defects a safe access and secure exit.
abstract: OBJECTIVE
  This study sought to evaluate the safety of percutaneous direct left ventricular access for interventional procedures.
  
  
  BACKGROUND
  Experience with percutaneous access of the left ventricle (LV) for interventional procedures has been limited and associated with a high percentage of major complications. We report our clinical experience with percutaneous direct LV access for interventional procedures.
  
  
  METHODS
  Between March 2008 and December 2010, there were 32 percutaneous transapical punctures in 28 consecutive patients (16 males, mean age 68.2 ± 10.8 years). The delivery sheath sizes ranged from 5- to 12-F.
  
  
  RESULTS
  All transapical punctures were successfully performed, and safe closure of the access sites was achieved. Total procedural time was 153.6 ± 49.4 min for procedures converted from conventional approaches to a transapical approach, 129.5 ± 29.6 min for the transapical approach with trans-septal rail support, and 109.3 ± 41.4 min for the planned transapical approach. Fluoroscopy time was 61.3 ± 26.1 min, 29.7 ± 20.8 min, and 27.4 ± 21.4 min, respectively. Fluoroscopy time for closure of mitral paravalvular leaks was reduced by 35%, from 42.6 ± 29.9 min to 27.4 ± 15.6 min. Complications were observed in 2 patients (7.1%).
  
  
  CONCLUSIONS
  With meticulous planning, transapical puncture is safe. The transapical access provides a more direct approach to the LV targets for intervention and leads to a significant decrease in the procedural and fluoroscopy times. Device closure of the direct LV access site is a reliable and safe method of hemostasis. Placement of a closure device should be considered if sheaths larger than 5-F are used. Although we used this technique only for paravalvular leak and LV pseudoaneurysm closure, it may have application for other percutaneous structural heart interventions.
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, New York 10021-10075, USA.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Jelnin
authors.forename: Yuriy
authors.initials: Y
authors.lastname: Dudiy
authors.forename: Bryce N
authors.initials: BN
authors.lastname: Einhorn
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kronzon
authors.forename: Howard A
authors.initials: HA
authors.lastname: Cohen
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ruiz
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D017023:Coronary Angiography / Q000379:methods; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D011677:Punctures; D013813:Therapy, Computer-Assisted; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome