Transapical Access for Percutaneous Mitral Paravalvular Leak Repair

Paravalvular leak (PVL) is a rare complication of mitral valve surgery that may result in serious clinical sequelae—including heart failure or hemolytic anemia. Treatment of these defects may be achieved with either percutaneous or open surgical repair, but recently, percutaneous approaches have become more popular due to their lower procedural risk. Percutaneous repair of mitral PVL can be performed from various access sites, including the femoral artery, femoral vein (via transeptal), or via transapical left ventricular access. The transapical approach provides simple, direct access to the entire mitral annulus—including areas that may not be reached from either transseptal or retrograde approaches. In addition, the short, in-line course from the apex to the mitral annulus simplifies delivery of large-caliber interventional equipment and limits procedural/fluoroscopy time. These advantages are counterbalanced by risk of complications, including left anterior descending coronary artery puncture and bleeding following sheath removal. This article reviews the literature addressing percutaneous PVL repair and the use of transapical access in the catheterization laboratory. We then describe our approach to percutaneous transapical mitral PVL repair.