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

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.

A case report of transcatheter repair of severe functional mitral regurgitation in cardiac amyloidosis

“…On the choice of TA or TF devices, the left ventricular apex has proved to be a safe and valid alternative access for various other structural heart procedures. 16 The comparison of the TA and TF approach has been extensively discussed in the transcatheter aortic valve implantation. 16–18 Although the transapical approach is more invasive compared with the TF approach, the outcome difference between TA and TE became acceptable because the device is constantly updated and the accumulated experience.…”

Special Issue “New Perspectives in Cardiovascular Surgery”

“…With the increased use of transfemoral approaches to perform minimally invasive cardiac surgery, Agostinelli and his co-authors [ 5 ] wanted to confirm the importance of the left ventricular apex as a safe and valid alternative to performing a variety of procedures such as valve repairs and replacements and thoracic aorta repairs.…”