Lenox Hill Heart and Vascular Institute of New York, New York, New York 10021-10075, USA.
JACC Cardiovasc Interv. 2011 Aug;4(8):868-74. doi: 10.1016/j.jcin.2011.05.018.
This study sought to evaluate the safety of percutaneous direct left ventricular access for interventional procedures.
Experience with percutaneous access of the left ventricle (LV) for interventional procedures has been limited and associated with a high percentage of major complications. We report our clinical experience with percutaneous direct LV access for interventional procedures.
Between March 2008 and December 2010, there were 32 percutaneous transapical punctures in 28 consecutive patients (16 males, mean age 68.2 ± 10.8 years). The delivery sheath sizes ranged from 5- to 12-F.
All transapical punctures were successfully performed, and safe closure of the access sites was achieved. Total procedural time was 153.6 ± 49.4 min for procedures converted from conventional approaches to a transapical approach, 129.5 ± 29.6 min for the transapical approach with trans-septal rail support, and 109.3 ± 41.4 min for the planned transapical approach. Fluoroscopy time was 61.3 ± 26.1 min, 29.7 ± 20.8 min, and 27.4 ± 21.4 min, respectively. Fluoroscopy time for closure of mitral paravalvular leaks was reduced by 35%, from 42.6 ± 29.9 min to 27.4 ± 15.6 min. Complications were observed in 2 patients (7.1%).
With meticulous planning, transapical puncture is safe. The transapical access provides a more direct approach to the LV targets for intervention and leads to a significant decrease in the procedural and fluoroscopy times. Device closure of the direct LV access site is a reliable and safe method of hemostasis. Placement of a closure device should be considered if sheaths larger than 5-F are used. Although we used this technique only for paravalvular leak and LV pseudoaneurysm closure, it may have application for other percutaneous structural heart interventions.
本研究旨在评估经皮直接左心室介入治疗的安全性。
经皮左心室（LV）介入治疗的经验有限，且并发症发生率较高。我们报告了经皮直接左心室介入治疗的临床经验。
2008 年 3 月至 2010 年 12 月，连续 28 例患者（16 例男性，平均年龄 68.2 ± 10.8 岁）进行了 32 例经心尖穿刺。输送鞘管大小为 5 至 12-F。
所有经心尖穿刺均成功完成，安全关闭了介入部位。从传统方法转为经心尖途径的总手术时间为 153.6 ± 49.4 分钟，经心尖途径并经隔轨道支持的手术时间为 129.5 ± 29.6 分钟，计划经心尖途径的手术时间为 109.3 ± 41.4 分钟。透视时间分别为 61.3 ± 26.1 分钟、29.7 ± 20.8 分钟和 27.4 ± 21.4 分钟。二尖瓣瓣周漏封堵的透视时间减少了 35%，从 42.6 ± 29.9 分钟降至 27.4 ± 15.6 分钟。2 例患者（7.1%）出现并发症。
精心规划下，经心尖穿刺是安全的。经心尖入路为介入治疗提供了更直接的左心室靶标途径，并显著减少了手术和透视时间。直接左心室介入部位的器械封堵是一种可靠和安全的止血方法。如果使用大于 5-F 的鞘管，则应考虑放置封堵器。尽管我们仅将该技术用于瓣周漏和 LV 假性动脉瘤封堵，但它可能适用于其他经皮结构性心脏介入治疗。
