Complete percutaneous apical access and closure: Short and intermediate term outcomes

Area of Science:

• Cardiovascular Interventions
• Structural Heart Disease
• Minimally Invasive Surgery

Background:

• Complex structural heart interventions often necessitate coaxial forces for device deployment.
• Apical access offers coaxial countertraction for transseptal or retrograde aortic approaches.
• This study details a single-center experience with small-bore transapical access.

Purpose of the Study:

• To evaluate the safety and feasibility of transapical access during structural heart interventions.
• To describe the outcomes of patients undergoing procedures utilizing small-bore transapical access.

Main Methods:

• Retrospective review of 21 cases performed between 2013 and 2018 at Henry Ford Hospital.
• Abstraction of patient demographics and procedural characteristics.
• Analysis of complications and long-term outcomes related to transapical access.

Main Results:

• Transapical access was primarily used for transcatheter mitral valve replacement (81%) with a mean sheath size of 4.7 mm.
• Four major complications occurred: two pericardial effusions and two hemothoraces.
• No deaths were directly associated with transapical access, and no late structural complications were detected from occluder devices.

Conclusions:

• Transapical access with nitinol-based closure devices is a feasible approach for complex interventions requiring coaxial alignment.
• Bleeding represents the most common complication and must be considered in high-risk patient populations.
• This technique facilitates device delivery and alignment in challenging structural heart procedures.