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Transfemoral transcatheter puncture of interventricular septum in a swine model: A novel transfemoral‐venous access to left ventricle with the assistance of arterio‐venous circuit
Author(s) -
Yan Chaowu,
Wan Linyuan,
Li Li,
Li Hua,
Du Baopeng,
Hao Shijie
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.28848
Subject(s) - medicine , femoral vein , interventricular septum , ventricle , shunt (medical) , surgery , femoral artery , shunting , cardiology
Objective Via subclavian/jugular vein, successful puncture of interventricular septum (IVS) has been achieved transvenously. However, the approach was limited by acute entry‐angle. The study was conducted to investigate a novel transcatheter puncture of IVS via femoral access and transfemoral‐venous access to left ventricle (LV) through IVS. Methods Via femoral artery, transcatheter puncture of mid‐IVS was performed with a custom‐made nickel–titanium needle and 6F‐sheath in 16 healthy mini‐swine. Then femoral arterio‐venous circuit was established through IVS. After pre‐dilation of IVS, a 20F‐sheath was introduced into LV transvenously over‐the‐guidewire in 15 swine. Furthermore, transfemoral‐venous TAVR was attempted with the approach in another swine. IVS was evaluated postoperatively and was further confirmed pathologically 2 months later. Results All transcatheter puncture of IVS was performed successfully in LV and the mid‐IVS thickness was 7.67 ± 0.98 mm. In all swine, femoral arterio‐venous circuit was established via IVS, and a 20F‐sheath was introduced into LV and aorta transfemoral‐venously (entry‐angle: 145.3 ± 12.2° in front view). After the procedure, there was one swine with moderate tricuspid‐regurgitation and five swine with mild residual‐shunt (2.6 ± 0.7 mm). Two months later, residual‐shunt was still detected in three swine and the communication was confirmed pathologically. In other swine, no defect occurred and replacement‐scar was identified along puncture‐tract. In the swine underwent transfemoral‐venous TAVR, prosthetic valve was deployed successfully with good function. Conclusions Transfemoral transcatheter puncture of IVS is feasible and safe in a swine model, and large sheath can be introduced into LV transfemoral‐venously using the novel access with the aid of vessel circuit.