Transapical access and closure devices: rationale and current status

Abstract

In the past years transcatheter aortic valve implantation became a highly standardized option for the treatment of high-risk patients suffering from severe aortic stenosis. The number of transcatheter aortic valve implantation procedures is increasing exponentially worldwide. In this context the transapical approach should be considered as a safe and reproducible alternative access to the left ventricle with some specific advantages compared with transfemoral, transaortic and transsubclavian approach due to its antegrade nature. To further ease the transapical access first apical closure devices have been developed and entered first clinical trials.

Keywords::

• aortic valve stenosis
• closure device
• transapical
• transcatheter aortic valve implantation
• transfemoral
• percutaneous

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Transapical (TA) approach provides a safe and reproducible approach with a very low complication rate.

• • TA access allows for the insertion of relatively large profile devices.

• • Short anatomical distance to both the mitral and the aortic valve.

• • Apical access and closure devices facilitate and further standardize TA technique.

• • Apical access and closure devices might flatten initial learning curve.

• • First clinical experience presents promising results.

• • The use of apical access and closure device could reduce the invasiveness.

• • The use of apical access and closure devices might allow for fully percutaneous approach briefly.

• • Use of apical access and closure devices also allow for mitral interventions.