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Transapical access and closure devices: rationale and current status.

Johannes Blumenstein1, Joerg Kempfert, Won Kim

  • 1Department of Cardiology, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.

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Transcatheter aortic valve implantation is a standard treatment for severe aortic stenosis. The transapical approach offers a safe alternative access, with new closure devices enhancing its use.

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Transcatheter aortic valve implantation (TAVI) is a well-established treatment for severe aortic stenosis in high-risk patients.
  • TAVI procedures are increasing globally, necessitating evaluation of different access routes.
  • The transapical approach is a viable alternative to other TAVI access methods.

Purpose of the Study:

  • To highlight the transapical approach as a safe and reproducible method for TAVI.
  • To discuss the advantages of the transapical approach over other TAVI access routes.
  • To introduce novel apical closure devices for the transapical approach.

Main Methods:

  • Review of existing literature on transcatheter aortic valve implantation.
  • Analysis of the transapical approach in comparison to transfemoral, transaortic, and transsubclavian methods.
  • Discussion of the development and initial clinical trials of apical closure devices.

Main Results:

  • The transapical approach is a safe and reproducible access route for TAVI.
  • The antegrade nature of the transapical approach offers specific advantages.
  • New apical closure devices are being developed to facilitate the transapical procedure.

Conclusions:

  • The transapical approach is a valuable option for TAVI, particularly due to its antegrade access.
  • Ongoing development of apical closure devices aims to further improve the safety and efficiency of this approach.
  • The transapical route remains a key consideration in the expanding field of TAVI.