Electrosurgical laceration and stabilisation of three clip devices (ELASTA-Clip) to enable transcatheter mitral valve implantation

Mitral transcatheter edge-to-edge repair (M-TEER) has been established as a treatment approach in symptomatic severe mitral regurgitation (MR) patients. However, even after successful M-TEER, some patients develop recurrent MR over time. Electrosurgical Laceration and Stabilization of Clip devices (ELASTA-Clip) is a novel technique for cutting a mitral tissue bridge, enabling subsequent transcatheter mitral valve implantation (TMVI)1. Very few ELASTA-Clip cases have been reported, and to date, this technique has only been applied in patients with one, or a maximum of two, M-TEER devices.

A 67-year-old female presented with highly symptomatic, recurrent severe MR 2.5 years after successful MitraClip M-TEER with three devices (MR reduced to 2+, mean gradient 3.0 mmHg). Given her symptomatic burden and high surgical risk, we decided to perform a triple ELASTA-Clip procedure with subsequent TMVI.

Transapical surgical access was prepared, and a 24 Fr DrySeal sheath (W.L. Gore & Associates) was placed in the femoral vein for dual guiding sheath insertion. Two 8.5 Fr steerable Agilis NxT (Abbott Vascular) guiding sheaths were placed transseptally. A Swan-Ganz balloon catheter was used to traverse the medial orifice...