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Review Article

Novel Solutions Applied in Transseptal Puncture: A Systematic Review

[+] Author and Article Information
Pedro Morais

ICVS/3B's—PT Government Associate Laboratory,
Braga/Guimarães 4710-057, Portugal;
Lab on Cardiovascular Imaging and Dynamics,
KU Leuven,
Leuven 3000, Belgium;
Instituto de Ciência e Inovação em Engenharia
Mecânica e Engenharia Industrial,
Faculdade de Engenharia,
Universidade do Porto,
Porto, Portugal

João L. Vilaça

ICVS/3B's—PT Government Associate Laboratory,
Braga/Guimarães 4710-057, Portugal;
DIGARC—Polytechnic Institute of Cávado
and Ave,
Vila Frescainha S. Martinho Barcelos 4750-810, Portugal

Joris Ector, Jan D'hooge

Lab on Cardiovascular Imaging & Dynamics,
Department of Cardiovascular Sciences,
University of Leuven,
Leuven, Belgium

João Manuel R. S. Tavares

Instituto de Ciência e Inovação em Engenharia
Mecânica e Engenharia Industrial,
Departamento de Engenharia Mecânica,
Faculdade de Engenharia,
Universidade do Porto,
Rua Dr. Roberto Frias, s/n,
Porto 4200-465, Portugal
e-mail: tavares@fe.up.pt

1Corresponding author.

Manuscript received May 20, 2016; final manuscript received November 16, 2016; published online January 24, 2017. Assoc. Editor: Michael Eggen.

J. Med. Devices 11(1), 010801 (Jan 24, 2017) (14 pages) Paper No: MED-16-1224; doi: 10.1115/1.4035374 History: Received May 20, 2016; Revised November 16, 2016

Access to the left atrium is required for several minimally invasive cardiac interventions in the left heart. For this purpose, transseptal puncture (TSP) technique is often performed, perforating the atrial septum under fluoroscopic or/and ultrasound imaging guidance. Although this approach has been used for many years, complications/failures are not uncommon mainly in patients with abnormal atrial anatomy and repeated TSP. Thus, this study presents an overview of methods and techniques that have been proposed to increase the safety and feasibility of the TSP. A systematic review of literature was conducted through the analysis of the articles published between 2008 and 2015. The search was performed in PubMed, Scopus, and ISI Web of Knowledge using the expression “transseptal puncture.” A total of 354 articles were retrieved from the databases, and 64 articles were selected for this review. Moreover, these 64 articles were divided into four categories, namely: (1) incidence studies, (2) intraprocedural guidance techniques, (3) preprocedural planning methods, and (4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intraprocedural guidance techniques, 5 works focused on preprocedural planning strategies, and 21 works proposed surgical instruments. The novel 3D guidance techniques, radio-frequency surgical instruments, and pre-interventional planning approaches showed potential to overcome the main procedural limitations/complications, through the reduction of the intervention time, radiation, number of failures, and complications.

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Haegeli, L. M. , Wolber, T. , Ercin, E. , Altwegg, L. , Krasniqi, N. , Novak, P. G. , Sterns, L. D. , Brunckhorst, C. B. , Lüscher, T. F. , and Leather, R. A. , 2010, “ Double Transseptal Puncture for Catheter Ablation of Atrial Fibrillation: Safety of the Technique and Its Use in the Outpatient Setting,” Cardiol. Res. Pract., 2010 p. 295297. [PubMed]
Medi, C. , Evered, L. , Silbert, B. , Teh, A. , Halloran, K. , Morton, J. , Kistler, P. , and Kalman, J. , 2013, “ Subtle Post-Procedural Cognitive Dysfunction After Atrial Fibrillation Ablation,” J. Am. Coll. Cardiol., 62(6), pp. 531–539. [CrossRef] [PubMed]
Feld, G. K. , and Yao, B. , 2014, “ Evaluation of the Safety and Effectiveness of the CryoMedix Cryoablation Catheter System for the Treatment of Atrial Flutter and Fibrillation,” J. Interventional Card. Electrophysiol., 39(1), pp. 37–44. [CrossRef]
De Ponti, R. , Marazzi, R. , Picciolo, G. , and Salerno-Uriarte, J. A. , 2010, “ Use of a Novel Sharp-Tip, J-Shaped Guidewire to Facilitate Transseptal Catheterization,” Europace, 12(5), pp. 668–673. [CrossRef] [PubMed]
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Taramasso, M. , Maisano, F. , Latib, A. , Denti, P. , Guidotti, A. , Sticchi, A. , Panoulas, V. , Giustino, G. , Pozzoli, A. , and Buzzatti, N. , 2014, “ Conventional Surgery and Transcatheter Closure Via Surgical Transapical Approach for Paravalvular Leak Repair in High-Risk Patients: Results From a Single-Centre Experience,” Eur. Heart J.–Cardiovasc. Imaging, 15(10), pp. 1161–1167. [CrossRef] [PubMed]
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Tzeis, S. , Andrikopoulos, G. , Deisenhofer, I. , Ho, S. Y. , and Theodorakis, G. , 2010, “ Transseptal Catheterization: Considerations and Caveats,” Pacing Clin. Electrophysiol., 33(2), pp. 231–242. [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 1

Transseptal puncture traditional technique. (a) A catheter is placed into the SVC; the catheter is pulled down and two movements are detected, namely: (b) entrance into the RA and (c) entrance into FO, (d) after the FO identification, (e) the puncture is performed.

Grahic Jump Location
Fig. 2

Overview of the methodology used to select the relevant articles for the current review. The identification of the relevant works was performed using Prisma Statement [13].

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