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Transapical Electrosurgical Laceration And Stabilization Of Mitral Clips Followed By Transcatheter Mitral Valve Replacement - A One Stop-shop
Ilinca Damian, Joerg Kellermair, Michael Grund, Clemens Steinwender, Georg Hagleitner, Andreas Zierer.
Kepler University Hospital, Linz, Austria.
BACKGROUND: 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 (MR) after TEER with prohibitive risk for conventional surgery. The original ELASTA CLIP procedure features a transseptal approach while TMVR has a transapical access. Hereby we tested the hypothesisthat a modified transapical ELASTA CLIP technique can be safely applied transapically allowing a straight-forward 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 two consecutive patients with severe MR 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 min and the mean fluoroscopy duration 22 min. At 30 days follow-up, both patients were alive without bleeding complications, reintervention, or valve dysfunction. Echocardiography showed a clinically not significant mild paravalvular leakage in both patients.
CONCLUSION: Modified transapical ELASTA CLIP procedure is technically feasible and safe at 30days. Procedure times are lower compared to previous reports of the original transseptalapproach.
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