Dilator method and needle method for atrial transseptal puncture: a retrospective study from a cohort of 4443 patients

Abstract

Our data suggest that the new dilator technique is much safer than that of the standard needle method. It needs relatively longer procedure time but results in significantly fewer episodes of severe complications. Particularly, the blunt tip of the dilator can be used to help locate the fossa ovalis. Therefore, the new dilator technique might be a better choice for relatively less-experienced operators.

Transseptal puncture by CTP-2 method

“…[2,3,9,11,16,17] Traditionally, left atriography was used for determine the optimal puncture site. It is a relatively safe method.…”

“…We have no parallel data for comparison; however, our historic controls showed a 0.33% TSP-related severe complications. [11] We believe that the improved outcome is not only due to the modified method but also due to more image data available prior to the TSP.…”

“…Data were collected and successful TSP was defined as described previously. [11] Briefly, TSP was considered to be successful if it was accomplished without any severe complications such as cardiac perforation, arterial thromboembolism, arterial air embolism, pericarditis, death, and any other complications secondary to TSP that required further intervention (such as iatrogenic atrial septal defect). As the operator's experience is an important factor involving the procedure success, only those operators who had performed more than 50 cases of TSP independently were included in our analysis.…”

“…Additionally, a silhouette of the left atrium (LA) is not clear in the patients with tricuspid insufficiency. [3,11–13] Moreover, the previous reported parameters to locate the puncture site for TSP under fluoroscopic guidance were mainly resulted from clinicians’ experiences or measurements on cadaver heart. The accuracy of cadaver measurement would be restricted by dehydration, eversion, or dissection.…”

Side-selective Atrial Transseptal Laser Puncture

“…Recently, a series of new technique refinements and adjunctive imaging tools have been tested with the aim to simplify and improve the TP. Thus, the dilator and needle methods, 12 novel sharp-tip, J-shaped guidewire, 13 nitinol guidewire, 14 radiofrequency energy delivery through the transseptal needle 15 have been used to facilitate TP. In addition, real-time three-dimensional and minimally invasive transesophageal echocardiography-guided TP have been applied for atrial fibrillation ablation.…”