Transseptal access through synthetic materials: An in vitro comparative study of radiofrequency and needle-based...

The transseptal approach for accessing left heart structures is commonly performed with metal needles and radiofrequency (RF) needles and wires, though how each device performs when crossing materials used in congenital heart disease (CHD) surgery is unknown.

To compare the efficacy of commercially available transseptal devices in puncturing select materials relevant to CHD surgery.

A custom-designed in vitro transseptal model was created. Transseptal devices included a metal needle, an RF needle, and an RF wire. Study materials included expanded polytetrafluoroethylene (ePTFE), polyester, and bovine pericardium; porcine atrial septum was the control material. The primary outcomes were (1) the number of 1-second RF pulses required to puncture for RF devices and (2) the peak force required to puncture for the metal needle.

Excluding ePTFE, RF-based devices punctured all materials at 5-10 g force with a single 1-second pulse. For ePTFE, the RF wire required a median of 4 seconds (range 2-6 seconds) of RF energy to puncture, whereas the RF needle failed entirely. The metal needle required higher forces across all materials, most drastically for polyester (median 277 g). The metal needle punctured ePTFE with reasonable force (median 68 g).

Commercially available RF transseptal platforms successfully puncture native septa, polyester, and bovine pericardium with short-duration RF energy delivered at low forces. Metal needles remain a cost-effective option when crossing native septum, ePTFE, and bovine pericardium. However, caution should be taken when puncturing polyester with the metal needle, given that substantially higher applied forces are required. The RF wire and metal needle are reasonable options for ePTFE puncture.