Transapical electrosurgical laceration and stabilization of mitral clips followed by transcatheter mitral valve replacement-A one-stop shop.

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.

[Transcatheter mitral valve replacement : Indications, options, and techniques as well as important aspects for perioperative care]. / Interventioneller Mitralklappenersatz : Indikationen, Möglichkeiten und Technik sowie wichtige Aspekte für die perioperative Betreuung.

Transcatheter therapy of the mitral valve is more challenging compared to the aortic valve. Interventional therapy with the Mitra-Clip system, mimicking the surgical edge-to-edge repair, was first introduced in 2003 and received the CE mark in 2008. The first implantation of the Tendyne system, which is currently the only commercially available system for mitral valve replacement, was performed in 2014, and routine clinical use was approved in 2020. Several new valve platforms are in clinical development and will expand the treatment portfolio. This article will discuss the clinical indications, technical challenges and specific requirements for perioperative management.

Transcatheter, Transapical Mitral Valve Replacement After Mitral Valve Annuloplasty.

Mitral regurgitation (MR) recurrence after annuloplasty can lead to high-risk reoperations affecting long-term outcome. Transcatheter, transapical mitral valve replacement (TMVR) is an alternative method to treat severe MR without the use of cardiopulmonary bypass. This report describes the case of an 80-year old man who had undergone a mitral annuloplasty in 2006 and who now presented with severe recurrent MR. We performed TMVR using the Tendyne system (Abbott Laboratories). Our experience showed that TMVR after annuloplasty can be a safe method, thus reducing the procedural time and providing an alternative to the MitraClip (Abbott Laboratories) in-the-ring and the transcatheter aortic valve in-the-ring concept.

First in Human: Transcatheter, Transapical Double Valve Replacement.

Transcatheter aortic valve replacement is a well-established therapy for severe aortic stenosis in patients with high surgical risk. Transcatheter mitral valve replacement just recently emerged as a novel modality to treat severe mitral regurgitation. We present the first case of a transcatheter, transapical native double valve replacement for severe aortic stenosis and mitral regurgitation. Our case shows that it is a safe and effective method, not requiring cardiopulmonary bypass and drastically reducing the procedural time. Therefore, patients with significant comorbidities that portend a high surgical risk with poor long-term outcome, may stand to benefit from this minimally invasive procedure.