The transventricular–transseptal access to the aortic root: a new route for extrapleural trans-catheter aortic stent-valve implantation

Liu, Ligang; Tozzi, Piergiorgio; Ferrari, Enrico; Segesser, Ludwig K. von

doi:10.1016/j.ejcts.2010.04.033

Cited by 7 publications

(13 citation statements)

References 17 publications

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“…The volume of septal scar is comparatively smaller than small CMR defects generated during otherwise uncomplicated percutaneous coronary intervention [18]. Liu and colleagues [12] report a similar “transventricular-transseptal” approach with a 5 cm subxiphoid incision to deliver a transcatheter aortic valve implant. They chose to close the iatrogenic ventricular septal defect with a nitinol occluder where our experience suggests this may be unnecessary.…”

Section: Discussionmentioning

confidence: 99%

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Transthoracic delivery of large devices into the left ventricle through the right ventricle and interventricular septum: preclinical feasibility

Halabi

Ratnayaka

Faranesh

et al. 2013

Journal of Cardiovascular Magnetic Resonance

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BackgroundWe aim to deliver large appliances into the left ventricle through the right ventricle and across the interventricular septum. This transthoracic access route exploits immediate recoil of the septum, and lower transmyocardial pressure gradient across the right versus left ventricular free wall. The route may enhance safety and allow subxiphoid rather than intercostal traversal.MethodsThe entire procedure was performed under real-time CMR guidance. An “active” CMR needle crossed the chest, right ventricular free wall, and then the interventricular septum to deliver a guidewire then used to deliver an 18Fr introducer. Afterwards, the right ventricular free wall was closed with a nitinol occluder. Immediate closure and late healing of the unrepaired septum and free wall were assessed by oximetry, angiography, CMR, and necropsy up to four weeks afterwards.ResultsThe procedure was successful in 9 of 11 pigs. One failed because of refractory ventricular fibrillation upon needle entry, and the other because of inadequate guidewire support. In all ten attempts, the right ventricular free wall was closed without hemopericardium. There was neither immediate nor late shunt on oximetry, X-ray angiography, or CMR. The interventricular septal tract fibrosed completely. Transventricular trajectories planned on human CT scans suggest comparable intracavitary working space and less acute entry angles than a conventional atrial transseptal approach.ConclusionLarge closed-chest access ports can be introduced across the right ventricular free wall and interventricular septum into the left ventricle. The septum recoils immediately and heals completely without repair. A nitinol occluder immediately seals the right ventricular wall. The entry angle is more favorable to introduce, for example, prosthetic mitral valves than a conventional atrial transseptal approach.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, knife injury across the interventricular septum often fails to induce persistent myocardial defects once hemopericardium is treated [10,11]. Liu and colleagues [12] report a different surgical approach to the LV across the RV free wall and interventricular septum in animals.…”

Section: Introductionmentioning

confidence: 99%

Transthoracic delivery of large devices into the left ventricle through the right ventricle and interventricular septum: preclinical feasibility

Halabi

Ratnayaka

Faranesh

et al. 2013

Journal of Cardiovascular Magnetic Resonance

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“…5 Transventricular septal access to the LV has been also reported in transcatheter aortic valve implantation procedures under intracardiac echocardiography (ICE) guidance. 11 The use of ICE during transventricular septal puncture has been recommended from the viewpoint of safety; however, while it is generally used in the United States, it is not common in Europe, as health insurance agencies do not cover the costs of ICE catheters. Subcostal echocardiography was particularly useful for the confirmation of no entrapment of the tricuspid septal leaflet at the transventricular access point in the current case.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Interventricular Septal Access Guided by Subcostal Echocardiography and Fluoroscopy for Ventricular Tachycardia Ablation in a Patient with Aortic and Mitral Mechanical Valves

Aras¹,

Topaloğlu²,

Özeke³

et al. 2019

J Innov Cardiac Rhythm Manage.

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Mechanical prosthetic aortic and mitral valves preclude either a retrograde aortic or transseptal approach to the left ventricular (LV) endocardium. Several operators have reported on the application of nonconventional techniques for ventricular tachycardia (VT) ablation including transventricular septal puncture, epicardial approach, transmechanical valve approach, transcoronary venous approach, and transapical approach. Incorporating transventricular access to the LV under intracardiac echocardiography (ICE) guidance has been previously attempted in VT ablation procedures in patients with both aortic and mitral mechanical valves. However, while ICE is readily used in the United States, its use is less common in Europe, since the health insurance agencies largely do not cover the costs of ICE catheters. We therefore herein present a case of VT ablation in the LV using a transventricular approach in a patient who underwent mechanical double valve replacement performed under subcostal echocardiographic and fluoroscopic guidance.

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“…21, 22 However, crossing the RV and inter-ventricular septum can increase the complication rate of either procedure alone and would still require the need for epicardial access and closure of the RV free wall. In this report, we describe obtaining LV access utilizing a superior approach (from the internal jugular vein) by crossing the inter-ventricular septum at its mid portion under ICE and fluoroscopic guidance with a therapeutic ACT of 300-350.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

Vaseghi¹,

Macias²,

Tung³

et al. 2013

Heart Rhythm

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IntroductionCatheter ablation of ventricular tachycardia (VT) is typically performed using either the atrial transseptal approach or a retrograde aortic approach in order to gain access to the left ventricle (LV). However, neither approach is feasible in the setting of mechanical aortic and mitral valve replacements, given the risk of catheter entrapment and death. 1, 2 Therefore, approaches that avoid traversing these valves, such as a percutaneous trans-apical approach, have been developed. [3][4][5][6] However, the trans-apical approach is associated with a significant rate of access related complications, particularly bleeding at the puncture site, and necessitates the placement of closure devices in the LV. 7,8 We describe a novel percutaneous inter-ventricular transseptal puncture technique and placement of a sheath across the inter-ventricular septum for catheter ablation of VT. This method allowed for stable LV access and spontaneous closure of the septal access site. Case Report Clinical HistoryA 35-year-old male was referred to our center for catheter ablation of recurrent VT requiring multiple implantable cardiac defibrillator (ICD) therapies. He had undergone mechanical aortic and mitral valve replacements after developing endocarditis due to a dental abscess. Five years later, he suffered from sudden cardiac arrest and a single-lead ICD was placed. His ejection fraction was estimated at 35% and Q waves were noted on the ECG in the inferior leads. He subsequently suffered from VT storm with increasing number of ICD shocks and anti-tachycardia pace terminated (ATP) episodes despite therapy with sotalol and © 2013 The Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.Address for correspondence: Kalyanam Shivkumar, M.D., Ph.D., FHRS, UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite # 660, Los Angeles, CA 90095, 310-206-2235 (phone), 310-825 4251 (Fax), kshivkumar@mednet.ucla.edu. Disclosure: The Regents of the University of California, Los Angeles has intellectual property developed by the author (KS) that relate to data reported in this paper.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. amiodarone, and also developed trans-aminitis secondary to amiodarone. In the past year, he had suffered from 110 episodes of VT requiring either ATP or ICD shocks and was highly symptomatic, even during the ATP episodes. Given the presence of mechanical prostheses in the mitral and aortic valve positions, a novel method of LV access across the interventricular septum was discussed wi...

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The transventricular–transseptal access to the aortic root: a new route for extrapleural trans-catheter aortic stent-valve implantation

Abstract: Trans-catheter implantation of aortic valved stent via extrapleural transventricular-transseptal access is technically feasible and has the potential for a simplified procedure under local anaesthesia.

Cited by 7 publications

References 17 publications

Transthoracic delivery of large devices into the left ventricle through the right ventricle and interventricular septum: preclinical feasibility

Transthoracic delivery of large devices into the left ventricle through the right ventricle and interventricular septum: preclinical feasibility

Percutaneous Interventricular Septal Access Guided by Subcostal Echocardiography and Fluoroscopy for Ventricular Tachycardia Ablation in a Patient with Aortic and Mitral Mechanical Valves

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

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