Percutaneous transapical closure of cardiac apex with an ADO-II device after successful transapical transcatheter prosthetic mitral paravalvular leak closure

Abstract

The transapical transcatheter approach for percutaneous interventions is performed in high-risk patients with peripheral vascular disease and when transseptal attempt failed. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, there are some complications and risks like ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding in the apical access even though it is a minimally invasive procedure [ [1] von Segesser L.K. Gerosa G. Borger M.A. Ferrari E. Prevention and management of potential adverse events during transapical aortic valve replacement. J. Heart Valve Dis. 2013; 22: 276-286 PubMed Google Scholar ]. Although new apical closure devices have been developed and tested in animals and humans, the apical closure remains a challenge in recent studies [ [2] Blumenstein J. Kempfert J. Van Linden A. et al. First-in-man evaluation of the transapical APICA ASC™ access and closure device: the initial 10 patients. Eur. J. Cardiothorac. Surg. 2013; 44: 1057-1062 Crossref PubMed Scopus (26) Google Scholar ]. The cardiologists started to use the occluders to closure the percutaneous apical accesses [ 3 Brinks H. Nietlispach F. Go¨ber V. et al. Transapical access closure: the TA PLUG device. Interact. Cardiovasc. Thorac. Surg. 2013; 17: 806-809 Crossref PubMed Google Scholar , 4 Rajeev Fernando, David F. Briceno, Pranav Loyalka, Biswajit Kar. Transapical closure of mitral paravalvular leak over a surgically constructed mitral annulus. Int. J. Cardiol. 171 (2) (2014) 302–304. Google Scholar , 5 Saskia Pokorny, Katharina Huenges, Telse Bähr, Jan Hinnerk Hansen, Gunther Fischer, Justus Gross, Michael Morlock, Jochen Cremer, and others. Transapical mitral valved stent implantation: enhanced survival and decreased paravalvular leakages. Int. J. Cardiol. 175 (3) (2014) 418–424. Google Scholar , 6 Giuseppe Bruschi, Federico De Marco, Luca Botta, Alberto Barosi, Paola Colombo, Silvia Mauri, Aldo Cannata, Nuccia Morici, and others. Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: a single center experience. Int. J. Cardiol. 181 (2015) 437–442. Google Scholar , 7 Ferrari E. Locca D. Berdajs D. Marcucci C. Gronchi F. Lavanchy J. Prêtre R. Tozzi P. Use of a ventricular septal defect occluder for apical closure in transapical aortic valve replacement. Innovations (Phila.). Jan–Feb 2015; 10: 68-70 Crossref PubMed Scopus (8) Google Scholar , 8 Blumenstein J. Kempfert J. Kim W. Liebetrau C. Möllmann H. Walther T. Transapical access and closure devices: rationale and current status. Expert. Rev. Cardiovasc. Ther. Dec 2013; 11: 1613-1617 Crossref PubMed Scopus (8) Google Scholar , 9 Brinks H. Nietlispach F. Göber V. Englberger L. Wenaweser P. Meier B. Carrel T. Huber C. Transapical access closure: the TA PLUG device. Interact. Cardiovasc. Thorac. Surg. Nov 2013; 17: 806-809 Crossref PubMed Scopus (12) Google Scholar , 10 Tang L. Fang Z. Hu X. Tang J. Shen X. Lu X. Zhao Y. Li J. Zhou S. Non-surgical repair of ventricular septal rupture after acute myocardial infarction. Int. J. Cardiol. Mar. 17 2015; 185: 328-332 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 11 Dardas P.S. Kelpis T.G. Ninios V.N. Mezilis N.E. Tsikaderis D.D. Pitsis A.A. Thanopoulos V.D. Successful transapical transcatheter prosthetic mitral paravalvular leak closure. Hell. J. Cardiol. Nov.–Dec. 2014; 55 (No abstract available.): 510-511 PubMed Google Scholar ]. We report a case of a successful percutaneous closure of the apical access with a 4 mm ADO-II device after a standard transapical mitral paravalvular leak closure procedure without minithoracotomy.