transapikal

Transapikal, or transapical, is a medical term describing an approach, access, or pathway that passes through the apex of an organ, most commonly the left ventricle of the heart. The word derives from Latin: trans- meaning through and apex meaning the tip or summit.

In cardiology and cardiac surgery, transapical access refers to puncturing and threading instruments through the apex of the left ventricle to reach the arterial system or intracardiac targets. This route is used to deliver devices or perform interventions when other access points are unsuitable or unavailable, such as in certain cases of transcatheter aortic valve replacement (TAVR or TAVI). The transapical approach typically requires a small surgical incision in the left chest (a thoracotomy) to expose the heart apex, followed by controlled puncture and cannulation of the ventricle and secure closure after the procedure.

Applications beyond TAVR include other transapical cardiac procedures, such as certain left ventricular biopsies or device deliveries where peripheral arteries are compromised. Risks associated with transapical procedures include bleeding, myocardial injury at the puncture site, pericardial effusion or tamponade, ventricular arrhythmias, and postoperative pain.

The transapical route has played a significant role in the evolution of less invasive cardiac interventions, particularly in the early development of transcatheter therapies. With advances in alternative access techniques, its use has become more selective, depending on patient anatomy and institutional expertise. See also transcatheter aortic valve implantation and left ventricular access.