Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Aug 27;10(17):3857.
doi: 10.3390/jcm10173857.

Left Ventricular Apex: A "Minimally Invasive Motorway" for Safe Cardiovascular Procedures

Andrea Agostinelli  1 , Alan Gallingani  1 , Francesco Maestri  1 , Silvia Grossi  2 , Florida Gripshi  1 , Luca De Donno  1 , Francesco Nicolini  1
Affiliations
Review

Left Ventricular Apex: A "Minimally Invasive Motorway" for Safe Cardiovascular Procedures

Andrea Agostinelli et al. J Clin Med. .

Abstract

Since the advent of TAVR (transcatheter aortic valve replacement), the transapical surgical approach has been affirmed as a safe and effective alternative access for patients with unsuitable peripheral arteries. With the improvement of devices for transfemoral approach and the development of other alternative accesses, the number of transapical procedures has decreased significantly worldwide. The left ventricular apex, however, has proved to be a safe and valid alternative access for various other structural heart procedures such as mitral valve repair, mitral valve-in-valve or valve-in-ring replacement, transcatheter mitral valve replacement (TMVR), transcatheter mitral paravalvular leak repair, and thoracic aorta endovascular repair (TEVAR). We review the literature and our experience of various hybrid transcatheter structural heart procedures using the transapical surgical approach and discuss pros and cons.

Keywords: transapical TAVR; transapical TEVAR; transapical approach; transapical mitral valve repair; transapical paravalvular leak repair; transcatheter mitral valve replacement.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Two haemostatic orthogonal U-shaped 2/0 polypropylene stitches on the left ventricular apex.
Figure 2
Figure 2
Easy engagement of mitral postero-medial paravalvular leak.
Figure 3
Figure 3
Pre-operative CT-scan: (a) 3D reconstruction of distal arch pseudo aneurysms due to penetrating aortic ulcers; (b) coronal view showing severe calcific occlusive disease of infra-renal aorta and peripheral arteries.
See this image and copyright information in PMC

References

    1. Cribier A., Eltchaninoff H., Bash A., Borenstein N., Tron C., Bauer F., Derumeaux G., Anselme F., Laboured F., Leon M.B. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation. 2002;106:3006–3008. doi: 10.1161/01.CIR.0000047200.36165.B8. - DOI - PubMed
    1. Lichtenstein S.V., Cheung A., Ye J., Thompson C.R., Carere R.G., Pasupati S. Transapical transcatheter aortic valve implantation in humans. Circulation. 2006;114:591–596. doi: 10.1161/CIRCULATIONAHA.106.632927. - DOI - PubMed
    1. D’Onofrio A., Rubino P., Fusari M., Salvador L., Musumeci F., Rinaldi M., Vitali E.O., Glauber M., Di Bartolomeo R., Alfieri O.R., et al. Clinical and hemodynamic outcomes of “all comers” undergoing transapical aortic valve implantation: Results from the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA) J. Thorac. Cardiovasc. Surg. 2011;142:768–775. doi: 10.1016/j.jtcvs.2011.06.026. - DOI - PubMed
    1. D’Onofrio A., Salizzoni S., Agrifoglio M., Cota L., Luzi G., Tartara P.M., Cresce G.D., Aiello M., Savini C., Cassese M., et al. Mid term outcomes of transapical aortic valve implantation: Results of the Italian Registry of Transapical Aortic Valve Implantation. Ann. Thorac. Surg. 2013;96:830–836. doi: 10.1016/j.athoracsur.2013.04.094. - DOI - PubMed
    1. Thourani V.H., Jensen H.A., Babaliaros V., Suri R., Vemulapalli S., Dai D. Transapical and transaortic transcatheter aortic valve replacement in the United States. Ann. Thorac. Surg. 2015;100:1718–1726. doi: 10.1016/j.athoracsur.2015.05.010. - DOI - PubMed