Transapical electrosurgical laceration and stabilization of mitral clips followed by transcatheter mitral valve replacement—A one-stop shopCentral MessagePerspective

Transapical electrosurgical laceration and stabilization of mitral clips followed by transcatheter mitral valve replacement—A one-stop shopCentral MessagePerspective

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 p...

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Main Authors: Joerg Kellermair, MD, Ilinca Damian, MD, Michael Grund, MD, Georg Hagleitner, MD, Florian Huber, MD, Michael Resl, MD, Gregor Sulzbacher, MD, Martin Clodi, MD, Clemens Steinwender, MD, Andreas Zierer, MD
Format: Article
Language:English
Published: Elsevier 2023-12-01
Series:JTCVS Techniques
Subjects:
ELASTA-CLIP
Tendyne
TMVR
transapical
electrosurgery
Online Access:http://www.sciencedirect.com/science/article/pii/S2666250723002766
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Summary: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.
ISSN:2666-2507

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