Electrosurgical Laceration and Stabilization of Clip Followed by Transapical Mitral Valve Replacement after Failed Transcatheter Edge-to-Edge Mitral Valve Repair: A Promising Alternative to Surgery.

Objectives: The study analyses perioperative outcomes in patients who underwent transcatheter electrosurgical laceration and stabilization of the clip (ELASTA-clip), followed by transapical mitral valve replacement or conventional mitral valve surgery (MVS) after failed transcatheter edge-to-edge mitral valve repair.

Methods: Consecutive patients who experienced failure of a transcatheter edge-to-edge mitral valve repair and subsequently underwent either the ELASTA-clip procedure followed by transapical mitral valve replacement or conventional open MVS were retrospectively analysed. Perioperative and mid-term outcomes including mortality, stroke, bleeding, pacemaker implantation, and the need for mechanical circulatory support were assessed descriptively.

Results: A total of 5 patients were enrolled in the ELASTA group and 31 in the open surgery group, with median follow-up periods of 2 years [IQR: 1.2-2.1] and 1.4 years [IQR: 0.3-3.7], respectively. Procedural success was achieved in all ELASTA cases (100%) compared to 96% in the open surgery group. No in-hospital deaths occurred in the ELASTA group, whereas the surgical group had a mortality rate of 6.5% (n = 2). During follow-up, adverse events occurred in 20% (n = 1) of ELASTA patients and 54.8% (n = 17) of those who underwent surgery.

Conclusions: Surgical intervention in patients with failed edge-to-edge mitral valve repair carries a high risk of complications. The ELASTA-clip technique, combined with transapical mitral valve replacement, offers a minimally invasive and safe alternative to conventional surgery, highlighting the need for further prospective studies with longer-term follow-up.