Transapical electrosurgical laceration and stabilization of mitral clips followed by transcatheter mitral valve replacement?A one-stop shop
Sprache des Titels:
Objective: Electrosurgical laceration and stabilization of mitral clips (ELASTA-CLIP)
is a bail-out technique to recreate a single-orifice mitral valve after transcatheter
edge-to-edge repair (TEER) with subsequent transcatheter mitral valve replacement
(TMVR). This technique is a novel option for patients with significant residual
mitral regurgitation after TEER with high risk for conventional surgery. The original
ELASTA CLIP procedure features a transseptal approach, whereas the TMVR with
the Tendyne bioprosthesis has a transapical access. Hereby we tested the hypothesis
that a modified transapical ELASTA CLIP technique can be safely applied transapically
allowing a straightforward one-stop shop access strategy.
Methods: We developed the procedural steps in a porcine passive-beating heart
model and applied the modified technique with subsequent TMVR in 2 consecutive
patients with severe mitral regurgitation after previous TEER. Patients were followed
up to 30 days.
Results: The modified transapical ELASTA CLIP procedure was successful in both
patients. The mean total procedure time was 118 minutes, and the mean fluoroscopy
duration 22 minutes. At 30 days? follow-up, both patients were alive without
bleeding complications, reintervention, or prosthetic valve dysfunction.
Conclusions: The modified transapical ELASTA CLIP procedure is technically
feasible and safe at 30 days. Procedure times are lower compared with previous reports
of the original transseptal approach. (JTCVS Techniques 2023;-:1-