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Complete percutaneous apical access and closure: Short and intermediate term outcomes
Author(s) -
Eng Marvin H.,
Kherallah Riyad Yazan,
Guerrero Mayra,
Greenbaum Adam B.,
Frisoli Tiberio,
Villablanca Pedro,
Wang Dee Dee,
Lee James,
Wyman Janet,
O'Neill William W.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28731
Subject(s) - medicine , percutaneous , surgery , demographics , complication , hemothorax , pneumothorax , demography , sociology
Objectives To examine the safety of utilizing transapical access during structural interventions. Background Complex interventions of the mitral or aortic region sometimes require coaxial forces to orient and deliver devices. Apical access can provide coaxial countertraction for either transseptal or retrograde aortic access. This manuscript describes the single center experience of small bore transapical access. Methods Retrospective review of cases from 2013 to 2018 at Henry Ford Hospital was performed. Patient demographics and procedure characteristics were abstracted to describe the safety of transapical access using small bore sheaths. Results A total 21 cases were performed at Henry Ford, most of them for transcatheter mitral valve replacement (81%). The mean sheath size used was 4.7 ± 0.9 Fr and protamine was used at the end of 57% of cases. All patients received nitinol‐based plugs, 80.1% were from the Amplatz Duct Occluder II type. Four major complications related apical puncture occurred, two pericardial effusions, two hemothorax. Over a median follow time of 430 days (IQR 50–652) a total of five deaths occurred, two related to the procedure and three late deaths with a median time of 362 days (range 205–628 days). No deaths were associated with transapical access. Echocardiographic follow up did not detect any late structural complications from occluder devices. Conclusions Transapical access and closure with nitinol‐based devices is feasible and facilitates complex interventions where coaxial forces are need for device delivery and alignment. The most common complication is bleeding and this should be kept in perspective when treating high‐risk patients.