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Immediate and late outcomes of patients undergoing transseptal left-sided heart catheterization for symptomatic
Tsun-Jui Liu1, Hui-Chin Lai, Wen-Lieng Lee
1Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Insights
Transseptal heart catheterization shows safe and effective outcomes for various heart conditions. While valvuloplasty patients may have more residual atrial septal defects, long-term prognosis remains unaffected.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Catheterization
Background:
- Transseptal technique is common for left-sided heart catheterization.
- Outcomes across different valvular and arrhythmic diseases are not well-defined.
Purpose of the Study:
- To evaluate immediate and late outcomes of transseptal procedures.
- Compare outcomes in diagnosis, arrhythmia, and valvuloplasty groups.
Main Methods:
- 176 patients (184 procedures) from 1993-2003 categorized by purpose.
- Acute events (perforation, stroke, bradyarrhythmia) and late complications (residual ASD, stroke, bradyarrhythmia, death) analyzed.
Main Results:
- Overall acute complication rate was 3.8%, similar across groups.
- No significant differences in late bradyarrhythmia, stroke, or death.
- Valvuloplasty group had higher residual ASD rates, but prognosis was unaffected.
Conclusions:
- Transseptal catheterization is safe for diverse cardiac conditions with good outcomes.
- Percutaneous valvuloplasty increases residual ASD risk but doesn't impact prognosis.
Background:
The transseptal technique has been widely used for diagnostic and therapeutic left-sided heart catheterization. However, its differential immediate and late outcomes among patients with various valvular and arrhythmic diseases are not yet determined.
Methods:
Beginning from 1993, all patients undergoing transseptal procedures were screened and categorized into diagnosis, arrhythmia, and valvuloplasty groups according to the purposes of the catheterization. Incidences of transseptum-related acute major events (cardiac perforation, embolic stroke, and bradyarrhythmia during the procedure) and late complications (residual atrial septal defect [ASD], embolic stroke, bradyarrhythmia, and death up to 18 months) were analyzed and compared between groups.
Results:
From January 1993 to May 2003, a total of 176 patients underwent 184 transseptal procedures for diagnosis of valvular heart diseases (n = 8), catheter ablation of arrhythmogenic foci (n = 29), and mitral valvuloplasty (n = 147). The immediate outcome was similar among the 3 groups, with an overall acute complication incidence of 3.8%. At follow-up, the incidences of bradyarrhythmia, embolic stroke, and death were not different among the 3 groups. Patients undergoing valvuloplasty had a significantly higher prevalence of residual ASD, especially for those with more severe mitral stenosis and less valvuloplasty success. However, presence of ASD did not impose disadvantage over the 1.5-year prognosis.
Conclusion:
Transseptal left-sided heart catheterization can be safely applied to patients with different categories of cardiac diseases with comparably good immediate and late outcomes. Although patients undergoing percutaneous valvuloplasty have a higher chance of permanent ASD creation, their prognosis is not influenced.
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