Hemodynamic Impact of Transseptal Access to the Ascending Aorta in a Porcine Model

Abstract

Transseptal access to the ascending aorta in a porcine model is feasible without persisting hemodynamic impairment or severe influence on myocardial or cerebral perfusion even with up to 16-F sheaths. Potential adverse effects need to be addressed before clinical use of this alternative access to the ascending aorta, aortic arch, and its side branches.

Transcardiac Endograft Delivery for Endovascular Treatment of the Ascending Aorta

“…12 Putting moderate tension on the T&T wire under fluoroscopy verified a correct and unimpeded guidewire course through the left ventricle without engagement of the papillary muscles and tendons.…”

“…The animals were endotracheally intubated and pressure-controlled ventilated at 15 cm H 2 O with a positive end-expiratory pressure of 7 cm H 2 O at 16 breaths per minute using 30% oxygen. Heparin (400 U/kg) was administered to achieve an activated clotting time of at least 300 seconds to prevent clotting of the fluorescent microspheres (FMs) used to quantitatively assess tissue perfusion 12,[14][15][16] and to obtain their homogenous distribution in the capillaries.…”

“…Iliac and aortic stenosis or tortuosity may further hinder endograft advancement and deployment in the proximal aorta. Recently, antegrade transcardiac techniques to access the ascending aorta have been described, [9][10][11][12][13] which may be used for introduction of endografts and mating stent-grafts and for catheterization of side branches of the aortic arch. Transapical access (TAA) uses the apex of the left ventricle as an entry point, either percutaneously or with prior surgical exposure through a mini thoracotomy.…”

“…11 Transseptal access (TSA) is established via the inferior vena cava (IVC) by puncturing the atrial septum and crossing the mitral and aortic valves, as described elsewhere using a soft externalized through-and-through (T&T) guidewire. 12,13 The aim of the present study was to compare the technical feasibility of and hemodynamic alteration associated with antegrade transcardiac access routes (TSA and TAA) vs conventional transfemoral access (TFA) for deployment of an endograft into the ascending aorta in a porcine model.…”

Complete Antegrade Transapical Deployment of a Branched Aortic Arch Endograft

“…In our previous experimental studies, [15][16][17] antegrade transcardiac access routes were successfully evaluated for endograft delivery in the ascending aorta and for antegrade side branch access. The aims of the present study were to describe and evaluate the technique for introducing a single-branch arch endograft through an antegrade transapical access in a porcine model and to assess hemodynamic changes as well as myocardial and cerebral blood flow before and after deployment.…”