title: Use of a ventricular septal defect occluder for apical closure in transapical aortic valve replacement.
abstract: During transapical transcatheter aortic valve replacement (TA-TAVR), the apical closure remains a challenge for the surgeon, having the risk for ventricular tear and massive bleeding. Apical closure devices are already under clinical evaluation, but only a few can lead to a full percutaneous TA-TAVR. We describe the successful use of a 9-mm myocardial occluder (ventricular septal defect occluder) that was used to seal the apex after a standard TA-TAVR (using the Sapien XT 23-mm transcatheter valve and the Ascendra + delivery system). The placement of the nonmodified myocardial occluder was performed through the Ascendra + delivery system, with a very small amount of blood loss and an acceptable sealing of the apical tear. This approach is feasible and represents a further step toward true-percutaneous transapical heart valve procedures. Modified apical occluders are under evaluation in animal models.
authors.affiliation: From the *Cardiac Surgery Unit, †Cardiology Unit, and ‡Cardiac Anesthesia Unit, University of Lausanne, Lausanne, Switzerland.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrari
authors.forename: Didier
authors.initials: D
authors.lastname: Locca
authors.forename: Denis
authors.initials: D
authors.lastname: Berdajs
authors.forename: Carlo
authors.initials: C
authors.lastname: Marcucci
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gronchi
authors.forename: Jerome
authors.initials: J
authors.lastname: Lavanchy
authors.forename: René
authors.initials: R
authors.lastname: Prêtre
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D055989:Septal Occluder Device; D016896:Treatment Outcome