Direct wire pacing for transcatheter mitral valve replacement

Failure after mitral annuloplasty or replacement is one of the long-term complications after mitral surgery. Reoperation in this frail population is associated with high postoperative mortality and morbidity1. Transcatheter mitral valve replacement (TMVR) procedures, including mitral valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC), have recently emerged as off-label alternative therapies for prosthesis dysfunction and severe mitral calcification2. Even though TMVR without rapid pacing has been successfully performed, it can improve valve stability and so optimises deployment and valve positioning. Temporary right ventricle pacing (RVP) is potentially associated with vascular and ventricular complications such as perforations and tamponades. Transcatheter procedures have undergone significant simplifications that have improved intervention duration, complication rates and patient outcomes particularly in this high-risk population. Direct wire pacing (DWP), as with direct left ventricular (LV) pacing in transcatheter aortic valve replacement (TAVR), has been shown to be as efficient as RVP. Procedural cost, duration and fluoroscopy time were significantly lower in the DWP group compared to the RVP group in TAVR3. Similarly to TAVR, we sought to simplify TMVR procedures without sacrificing...