Objective: Interventional targets may be “excluded” due to vascular problems or complex surgery. This study reviews our experience using transapical ventricular puncture.
Patients: Patient 1 (74y, 2 sternotomies), patient 2 (66y, 5 sternotomies) and patient 5 (69 y, 3 sternotomies) had paravalvular mitral valve leaks. Patient 3 (6.3y, 2 sternotomies) extracardiac Fontan, residual leak after 2 surgical attempts of patch closure of regurgitant atrioventricular valve. Patient 4 (10mo) had failure of standard ablation of the posteroseptal region of the mitral valve with persistent life-threatening ventricular tachycardia.
Methods: general anesthesia. Entry: LV apex percutaneous 3; mini-thoracotomy 2 (1 conversion). 1-3 6Fr sheaths were placed, followed by the procedure as required. Direct surgical closure of the puncture site was done in 4 patients and in patient 3, a percutaneous vascular occlusion device was used.
Results: Easy and immediate access was obtained in all patients. The paravalvular leaks were crossed within seconds and completely closed with 1 – 3 Amplatzer occluders. In patient 3 the valve was crossed using a Brokenbrough needle and a 12mm Amplatzer device was placed in the patch leak. Patient 4 was successfully ablated using a 7 Fr irrigated catheter endo- and epicardially. Complications were in the percutaneous puncture group only: coronary artery puncture 1, hemothorax 1, both treated percutaneously.
Conclusion: Direct left ventricular puncture offers a very useful alternative access site in selected patients to reach “inaccessible” targets for certain percutaneous interventions in patients where standard approaches may be impossible or difficult.