Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart disease

Gowda, Srinath T.; Qureshi, Athar M.; Turner, Daniel R.; Madan, Nitin; Weigand, Justin; Lorber, Richard; Singh, Harpreet

doi:10.1002/ccd.27202

Cited by 12 publications

(15 citation statements)

References 19 publications

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“…Additional imaging tools were not used in our series. In general, structural abnormities like a thick-/fibrotic or aneurysmatic interatrial septum in patients with CHD may present a challenge for TSP [ 8 ]. For these procedures, safety and efficacy of TSP may be improved by additional imaging tools like TTE [ 8 ], TEE [ 9 ] or ICE [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…In general, structural abnormities like a thick-/fibrotic or aneurysmatic interatrial septum in patients with CHD may present a challenge for TSP [ 8 ]. For these procedures, safety and efficacy of TSP may be improved by additional imaging tools like TTE [ 8 ], TEE [ 9 ] or ICE [ 10 ]. TEE and ICE reflect intracardial anatomy in more detail than TTE or fluoroscopy alone [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The RF technique utilizes high-frequency electrical current in contrast to mechanical energy using the traditional Brockenbrough approach. RF may be delivered directly via the tip of the transseptal needle for TSP in small CHD patients [ 8 ]. In a series of 7 patients with CHD < 1 year of age the procedure was successful in 6/7 infants.…”

Section: Discussionmentioning

confidence: 99%

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Safety of Transseptal Puncture for Access to the Left Atrium in Infants and Children

et al. 2021

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Transseptal puncture (TSP) is a standard procedure to obtain access to the left heart. However, data on TSP in infants and children particularly with congenital heart defects (CHD) is sparse. Safety and efficacy of TSP in infants and children < 18 years with normal cardiac anatomy and with CHD were assessed. 327 TSP were performed in a total of 300 individuals < 18 years from 10/2002 to 09/2018 in our tertiary pediatric referral center. Median age at TSP was 11.9 years (IQR 7.8–15; range: first day of life to 17.9 years). 13 subjects were < 1 year. Median body weight was 43.8 kg (IQR 26.9–60; range: 1.8–121 kg). CHD was present in 28/327 (8.6%) procedures. TSP could be successfully performed in 323/327 (98.8%) procedures and was abandoned in 4 procedures due to imminent or incurred complications. Major complications occurred in 4 patients. 3 of these 4 subjects were ≤ 1 year of age and required TSP for enlargement of a restrictive atrial septal defect in complex CHD. Two of these babies deceased within 48 h after TSP attempt. The third baby needed urgent surgery in the cath lab. Pericardial effusion requiring drainage was noted in the forth patient (> 1 year) who was discharged well later. Minor complications emerged in 5 patients. The youngest of these individuals (0.3 years, 5.8 kg) developed small pericardial effusion after anterograde ballon valvuloplasty for critical aortic stenosis. The remaining 4/5 patients developed small pericardial effusion after ablation of a left-sided accessory atrioventricular pathway (6.1–12.2 years, 15.6–34.0 kg). TSP for access to the left heart was safe and effective in children and adolescents > 1 year of age. However, TSP was a high-risk procedure in small infants with a restrictive interatrial septum with need for enlargement of interatrial communication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety of Transseptal Puncture for Access to the Left Atrium in Infants and Children

et al. 2021

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“…RF energy use, either with electrocautery application to a standard transseptal needle or with a specialized needle, has been shown to require less force to achieve transseptal puncture, and theoretically reduces the risk to surrounding structures. 12,13 In this case, RF application to the transseptal needle enabled crossing where careful image guidance of a transseptal needle with visualized tenting of the Dacron ASD patch, and attempts at SafeSept wire crossing, did not.…”

Section: Discussionmentioning

confidence: 85%

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Fitzgerald

May

Mahmoodi

et al. 2020

HeartRhythm Case Reports

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“…4,7,8 While application of electrocautery to the proximal end of a mechanical transseptal needle has been used to facilitate catheterization of difficult septa, electrosurgical parameters have not been clearly defined or optimized for TSP, and there is variability between operators in power settings (20-50W), RF application times (up to 11s) and the number of energy applications required. [9][10][11][12][13][14] More importantly, electrifying a hollow needle can cause coring of cardiac tissue, presenting a risk of systemic embolization. 15 Use of electrocautery with standard metal guidewires has been proposed as an alternative to perform TSP; 16 however, the safety and effectiveness of this approach is unknown.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Safety and Effectiveness of Dedicated Radiofrequency Transseptal Wires to Electrified Metal Guidewires

Wasserlauf

Knight

2021

Preprint

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Application of electrocautery to a metal guidewire can be used to perform transseptal puncture (TSP). Dedicated radiofrequency guidewires (RF) may represent a better alternative. This study compares safety and effectiveness of electrified guidewires to a dedicated RF wire. TSP was performed on porcine hearts using an electrified 0.014” or 0.032” guidewire under various power settings compared to TSP using a dedicated RF wire with 5W power. The primary endpoint was the number of attempts required to achieve TSP. Secondary endpoints included the rate of TSP failure, TSP consistency, effect of the distance between tip of the guidewire and the tip of the dilator, and effect of RF power output level. Qualitative secondary endpoints included tissue puncture defect appearance, thermal damage to the TSP guidewire or dilator, and tissue temperature using thermal imaging. The RF wire required 1.10 ± 0.47 attempts to cross the septum. The 0.014” electrified guidewire required 2.17 ± 2.36 attempts (2.0x higher than the RF wire; p<0.01), and the 0.032” electrified guidewire required 3.90 ± 2.93 attempts (3.5x higher than the RF wire; p<0.01). Electrified guidewires had a higher rate of TSP failure, larger defects, more tissue charring, higher temperatures, and greater tissue heating. Fewer RF applications were required to achieve TSP using a dedicated RF wire compared to an electrified guidewire. Smaller defects and lower tissue temperatures were also observed using the RF wire. Electrified guidewires required greater energy delivery and were associated with equipment damage and tissue charring.

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Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart disease

Abstract: RF current delivery using surgical electrocautery for TSP is a feasible and an effective option in patients with complex CHD for diagnostic, interventional, and electrophysiology procedures.

Cited by 12 publications

References 19 publications

Safety of Transseptal Puncture for Access to the Left Atrium in Infants and Children

Safety of Transseptal Puncture for Access to the Left Atrium in Infants and Children

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Comparing the Safety and Effectiveness of Dedicated Radiofrequency Transseptal Wires to Electrified Metal Guidewires

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