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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, Portugal; Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Belgium; Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Portugal
pedro.g.morais17@gmail.com

João Vilaça

ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; DIGARC – Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
jvilaca@ipca.pt

Joris Ector

Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
joris.ector@uzleuven.be

Jan Dhooge

Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Belgium
jan.dhooge@uzleuven.be

Joao Tavares

Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Portugal
tavares@fe.up.pt

1Corresponding author.

ASME doi:10.1115/1.4035374 History: Received May 20, 2016; Revised November 16, 2016

Abstract

Purpose: 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. Methods: 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”. Results: 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) intra-procedural guidance techniques; 3) pre-procedural planning methods and 4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intra-procedural guidance techniques, 5 works focused on pre-procedural planning strategies and 21 works proposed surgical instruments. Conclusions: 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.

Copyright (c) 2016 by ASME
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