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

Joerg Kellermair; Ilinca Damian; Michael Grund; Georg Hagleitner; Florian Huber; Michael Resl; Gregor Sulzbacher; Martin Clodi; Clemens Steinwender; Andreas Zierer

doi:10.1016/j.xjtc.2023.07.028

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

JTCVS Tech. 2023 Aug 19:22:189-196. doi: 10.1016/j.xjtc.2023.07.028. eCollection 2023 Dec.

Authors

Joerg Kellermair^{1

2}, Ilinca Damian³, Michael Grund¹, Georg Hagleitner⁴, Florian Huber^{2

3}, Michael Resl^{2

5}, Gregor Sulzbacher³, Martin Clodi^{2

5}, Clemens Steinwender^{1

2}, Andreas Zierer^{2

3}

Affiliations

¹ Department of Cardiology and Internal Intensive Care Medicine, Kepler University Hospital Linz, Linz, Austria.
² Institute for Cardiovascular and Metabolic Research (ICMR), Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria.
³ Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital Linz, Linz, Austria.
⁴ Central Radiology Institute, Kepler University Hospital Linz, Linz, Austria.
⁵ Department of Medicine, St John of God Hospital Linz, Linz, Austria.

Abstract

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.

Keywords: ELASTA-CLIP; TMVR; Tendyne; electrosurgery; transapical.