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

• Main Authors: Andrea Agostinelli, Alan Gallingani, Francesco Maestri, Silvia Grossi, Florida Gripshi, Luca De Donno, Francesco Nicolini
• Format: Article
• Language: English
• Published: MDPI AG 2021-08-01
• Series: Journal of Clinical Medicine
• Subjects: transapical approach; transapical TAVR; transapical TEVAR; transapical mitral valve repair; transcatheter mitral valve replacement; transapical paravalvular leak repair
• Online Access: https://www.mdpi.com/2077-0383/10/17/3857

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.