Electrosurgical Laceration and Stabilization of a Failed Mitral Edge-to-Edge Device Before Transcatheter Mitral Valve Replacement: The Importance of a Trans-Septal Approach

Antonio Mangieri; Giovanni La Canna; Andrea Davide Fumero; Ottavia Cozzi; Giulio Giuseppe Stefanini; Francesco Tartaglia; Lucia Torracca; Bernhard Reimers; Damiano Regazzoli

doi:10.1016/j.jaccas.2025.104297

Electrosurgical Laceration and Stabilization of a Failed Mitral Edge-to-Edge Device Before Transcatheter Mitral Valve Replacement: The Importance of a Trans-Septal Approach

JACC Case Rep. 2025 Jul 30;30(21):104297. doi: 10.1016/j.jaccas.2025.104297. Epub 2025 May 22.

Authors

Antonio Mangieri¹, Giovanni La Canna², Andrea Davide Fumero², Ottavia Cozzi³, Giulio Giuseppe Stefanini³, Francesco Tartaglia⁴, Lucia Torracca³, Bernhard Reimers², Damiano Regazzoli²

Affiliations

¹ Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: antonio.mangieri@gmail.com.
² Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy.
³ Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy.
⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy.

Abstract

Background: Electrosurgical laceration and stabilization of failed MitraClip(s) (ELASTA-Clip) has been proposed as a novel technique to cut the anterior mitral leaflet. A simplified transapical approach has been suggested.

Case summary: An 83-year-old man was admitted for recurrent, symptomatic mitral regurgitation after edge-to-edge (ETE) repair with PASCAL due to incomplete closure of the device. A transapical ELASTA failed despite multiple attempts. The procedure was then switched trans-septally and successfully performed without interference with the device. A transapical Tendyne was then implanted without any issue.

Discussion: The case highlights that ELASTA can fail in case of transapical approach for possible wire impingement in the PASCAL.

Take-home message: Transfemoral ELASTA should be preferred particularly in case of failed ETE due to partial closure of the ETE device.

Keywords: edge to edge; electrosurgery; mitral regurgitation; transcatheter mitral valve replacement.

Publication types

Case Reports