Percutaneous transaxillary arterial access for closure of post-infarction ventricular septal defect

Post-infarction ventricular septal defect (PiVSD) is a rare but fatal complication of myocardial infarction (MI). Percutaneous closure via conventional venous access and venoarterial rail increases procedural complexity and time, exerts strain on surrounding septal tissue, and results in device angulation. Whilst such drawbacks can be mitigated with the transaxillary arterial approach, the acute safety and long-term efficacy are unreported.

We included all patients undergoing percutaneous transaxillary transarterial PiVSD closure in two large tertiary centres in England from April 2020 to May 2025. Procedural data, periprocedural, in-hospital and 1-year mortality were determined through review of local and national electronic records.

Nine patients with comorbid cardiogenic shock were included. The median duration from MI to PiVSD closure was 4 (interquartile range 3-11) days. Right axillary access was used in all cases. The device implanted was either a 24 mm Amplatzer P.I. Muscular VSD Occluder or a larger Amplatzer Septal Occluder (Abbott, USA) necessitating an 80 cm 12F introduction sheath. Closure of the PiVSD was technically successful in all patients with reduction of the interventricular shunt to mild or less in eight of them. One patient died periprocedurally due to device erosion and cardiac tamponade. In-hospital death occurred in seven patients (77.8 %), in five of whom (55.6 %) death was attributed to cardiovascular causes. The two surviving patients had no further adverse events during 36 months of follow-up.

Transaxillary access is a technically reasonable approach for transarterial PiVSD closure. Periprocedural mortality is acceptable in a severely sick population. Survivors to discharge do well on longer-term follow-up.