Sharma Gaurav, Singh Gagan D, Smith Thomas W, Fan Dali, Low Reginald I, Rogers Jason H
Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
Catheter Cardiovasc Interv. 2017 May;89(6):E200-E206. doi: 10.1002/ccd.26608. Epub 2016 May 24.
Our objectives were to assess for differences between standard and radiofrequency (RF) needle in procedural times, success, and spatial accuracy.
Targeted transseptal (TS) puncture is essential for structural heart interventions. Spatial accuracy of standard versus RF needle has not been reported.
Consecutive patients undergoing structural heart interventions requiring TS puncture were studied retrospectively. A standard needle was alternated with a RF needle. Procedural success and times were recorded. Measurements based on intraprocedural transesophageal echocardiograms of the intended versus final TS crossing site were obtained. Pre-puncture and maximal tenting of the septum were also recorded.
Twenty-five patients underwent standard needle and 27 RF TS access. All RF needle attempts to cross were successful without an assistance wire. Three standard needle patients required assisted crossing. After failed TS access, two patients had successful RF TS access. TS procedural times significantly favored the RF needle for time from septum to puncture (P = 0.02). Both standard and RF access yielded accurate crossing with no significant differences between the intended and actual crossing site. Maximal tenting was significantly less with the RF needle (P = 0.004). There were no major complications.
In the hands of an experienced operator, there were no major clinically significant differences between the standard and RF needle approaches. However, procedural unassisted crossing success was higher with the RF needle approach as compared to standard needle. Procedural times and degree of septum tenting favored the RF over standard needle. Accuracy was similar with both approaches. RF was a successful strategy when standard needle failed. There were no major complications with either TS puncture strategy. © 2016 Wiley Periodicals, Inc.
我们的目的是评估标准针与射频（RF）针在操作时间、成功率和空间准确性方面的差异。
靶向经房间隔（TS）穿刺对于结构性心脏介入治疗至关重要。标准针与RF针的空间准确性尚未见报道。
对连续接受需要TS穿刺的结构性心脏介入治疗的患者进行回顾性研究。标准针与RF针交替使用。记录操作成功率和时间。基于术中经食管超声心动图获取预期与最终TS穿刺部位的测量值。还记录了穿刺前和房间隔的最大膨出情况。
25例患者接受了标准针TS穿刺，27例接受了RF针TS穿刺。所有RF针穿刺尝试均成功，无需辅助导丝。3例使用标准针的患者需要辅助穿刺。在TS穿刺失败后，2例患者通过RF针TS穿刺成功。TS操作时间在从房间隔到穿刺的时间方面明显有利于RF针（P = 0.02）。标准针和RF针穿刺均实现了准确穿刺，预期穿刺部位与实际穿刺部位之间无显著差异。RF针的最大膨出明显更小（P = 0.004）。无重大并发症。
在经验丰富的操作者手中，标准针与RF针方法之间没有重大的临床显著差异。然而，与标准针相比，RF针方法的操作无辅助穿刺成功率更高。操作时间和房间隔膨出程度方面RF针优于标准针。两种方法的准确性相似。当标准针失败时，RF针是一种成功的策略。两种TS穿刺策略均无重大并发症。© 2016威利期刊公司
