Percutaneous transapical access provides a direct route to many cardiac structures difficult to reach with conventional interventional approaches. With recent developments of new technologies in structural heart disease, there has been an increasing interest in the use of transapical access for cardiac interventions. Meticulous planning, careful access and closure techniques are essential. Development of novel imaging technologies and dedicated closure devices are warranted to allow a greater number of operators to successfully adopt percutaneous transapical access and further reduce complication rates. This article is an overview of the current status and utility of percutaneous transapical access with focus on multimodality imaging, technique and potential complications of this approach.