Transatrial access to the normal pericardial space for local cardiac therapy: Preclinical safety testing with aspirin and pulmonary artery hypertension

Abstract

The reliability, rapidity, and safety of nonsurgical, transatrial pericardial access for local cardiac therapy have been demonstrated in healthy animals. Since many patients take aspirin or have increased right-sided pressures, we evaluated the procedure's safety under these conditions. Transatrial pericardial access was performed in anesthetized pigs following aspirin administration (162 mg po, n = 6) or during experimental pulmonary artery hypertension (n = 4 different animals) and required only 3 minutes following guide catheter positioning. Platelet aggregability testing with arachidonic acid confirmed aspirin effectiveness. Mean pericardial fluid hematocrit was 0.1 ± 0.1% after 2 days of aspirin therapy and 1.9 ± 1.1% at sacrifice 24 hours later (NS). Mean pericardial fluid hematocrit was 1.0 ± 0.5% after 45 minutes of pulmonary artery hypertension and 4.3 ± 0.8% at sacrifice 30 minutes later (NS). Histologic analysis in both groups revealed a small thrombus and localized inflammation at the site of puncture. Neither aspirin use nor pulmonary artery hypertension causes significant bleeding into the pericardial space following transatrial access and thus does not preclude this route for local cardiac drug delivery.