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Left atrial and ventricular transseptal catheterization review: losing skills?
Insights
Transseptal catheterization, a procedure to evaluate the left heart, carries risks but maintains proficiency with continued use. Despite a decline in its application, proficiency is key to minimizing complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Catheterization
Background:
- Transseptal catheterization has been a routine procedure for left heart evaluation for 19 years.
- A decline in transseptal studies has been observed due to shifts in diagnostic focus and non-invasive techniques.
- This decline has led to a potential loss of proficiency in the technique.
Purpose of the Study:
- To review the safety and efficacy of transseptal catheterization over a 19-year period.
- To analyze complication rates in a large cohort of transseptal procedures.
- To assess the impact of declining usage on procedural proficiency.
Main Methods:
- Retrospective review of 250 consecutive transseptal heart catheterizations performed between 1978 and 1986.
- Analysis of patient demographics, procedural indications, and complication rates.
- Inclusion of data from patients with various cardiac conditions and prosthetic valves.
Main Results:
- Successful left heart entry in 244 out of 250 patients (97.6%).
- One death and four major complications were reported.
- The study included diverse patient groups, including those with valvular heart disease and post-valve replacement.
Conclusions:
- Transseptal catheterization, while potentially hazardous, demonstrates a low complication rate when performed proficiently.
- Continued utilization of the technique is essential for maintaining invasive cardiologists' skills.
- The findings underscore the importance of ongoing training and practice to ensure patient safety in interventional cardiology.
Abstract:
Transseptal catheterization has been routinely done at this institution for the past 19 years to evaluate the left heart. Reviewing the last 250 consecutive transseptal heart catheterizations between 1978 and 1986, the left atrium and ventricle were entered in all but six patients. One death occurred with four other major complications. There were 177 males and 73 females ranging from 18 to 84 years of age. Of these 250 studies, 31 were in association with direct left ventricular apical puncture; 42 were in patients with subaortic stenosis; 101 were in aortic stenosis; 26 were in patients with combined aortic and mitral disease; and four were in patients with triple prosthetic valve replacements. No attempts were made to cross the prosthetic mitral valves. A decline in the number of transseptal studies at this institution has been noted over the past 8 years and the technique is not longer taught routinely to Fellows. The reduction is due to increased emphasis on coronary artery anatomy, fewer rheumatic and prosthetic valvular admissions, and improved reevaluation by non-invasive echocardiography and doppler studies. This has resulted in a loss in proficiency among invasive cardiologists. In conclusion, the transseptal technique is potentially hazardous, but continued usage will maintain proficiency and a low major and minor complication rate.