Electrosurgical Detachment of MitraClips From the Anterior Mitral Leaflet Prior to Transcatheter Mitral Valve Implantation

• Authors: JC Lisko, Emory Univ Hosp Midtown; Adam Greenbaum, Emory University; Robert Guyton, Emory University; N Kamioka, Emory Univ Hosp Midtown; Kendra Grubb, Emory University; Patrick Gleason, Emory University; Isida Byku, Emory University; Jose Condado Contreras, Emory University; A Jadue, Emory Univ Hosp Midtown; Gaetano Paone, Emory University; Peter Block, Emory University; Lucia Alvarez, Emory University; Joe Xie, Emory University; JM Khan, NHLBI; T Rogers, NHLBI; Robert Lederman, Emory University; Vasilis Babaliaros, Emory University
• Journal Title: JACC: Cardiovascular Interventions
• Volume: Volume 13, Number 20
• Publisher: Elsevier Science Inc. | 2020-10-26, Pages 2361-2370
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jcin.2020.06.047
• Subjects: Health Sciences, Health Care Management; Health Sciences, Public Health; Engineering, Biomedical
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; MitraClip; mitral regurgitation; transcatheter electrosurgery; transcatheter mitral valve implantation; Outflow tract obstruction; Regurgitation; Replacement; Laceration; Definitions; Repair; Impact

Abstract

OBJECTIVES The aim of this study was to test the hypothesis that transcatheter electrosurgery might allow intentional detachment of previously placed MitraClip(s) from the anterior leaflet to recreate a single mitral orifice for transcatheter mitral valve implantation (TMVI), leaving the retained MitraClip(s) securely fastened to the posterior leaflet and without interfering with the mitral bioprosthesis. BACKGROUND Patients with severe mitral regurgitation or stenosis despite edge-to-edge mitral repair with the MitraClip typically have few therapeutic options because the resultant double orifice precludes TMVI. Transcatheter electrosurgery may allow detachment of failed MitraClip(s) from the anterior leaflet to recreate a single orifice for TMVI. METHODS This was a single-center, 5-patient, consecutive, retrospective observational cohort. Patients underwent transcatheter electrosurgical laceration and stabilization of failed MitraClip(s) to recreate a single orifice, leaving the MitraClip(s) securely fastened to the posterior leaflet. Subsequently, patients underwent TMVI with an investigational device, the Tendyne mitral bioprosthesis, on a compassionate basis. Patients were followed up to 30 days. RESULTS MitraClip detachment from the anterior leaflet and Tendyne implantation were successful in all patients. All patients survived to discharge. All patients were discharged with grade 0 central mitral regurgitation. Two patients had moderate perivalvular mitral regurgitation that did not require reintervention. During the follow-up period of 30 days, there were no deaths, cases of valve dysfunction, or reintervention. There was no evidence of erosion or bioprosthetic valve dysfunction attributable to the retained MitraClip(s) still attached to the posterior leaflet. CONCLUSIONS Transcatheter electrosurgical detachment of failed MitraClips from the anterior leaflet followed by TMVI is technically feasible and safe at 30 days. Longer term study is needed to determine the clinical benefit of this approach and new algorithms for TMVI sizing following electrosurgical laceration and stabilization of a failed MitraClip to avoid perivalvular leak.