Transseptal Device Comparison for Improved Puncture and Streamlined Mitral Edge-To-Edge Repair

Background Septal anatomy dictates the complexity of transseptal puncture (TSP) and strongly influences left atrial access for large mitral transcatheter edge-to-edge mitral valve repair. This study aimed to compare 2 TSP needle-based techniques—mechanical needle (MN; BRK Transseptal Needle, Abbott) and radiofrequency-powered needle (RFN; NRG Transseptal Needle, Boston Scientific)—with the VersaCross Large Access system (VLA, Boston Scientific), comprising a radiofrequency wire and 12.5F transseptal introducer. Methods This is a retrospective single-center review of consecutive MitraClip (Abbott) cases using MN (n = 28), RFN (n = 55)—both with an 8.5F sheath and pigtail exchange wire, and VLA (n = 109). Procedures were evaluated for TSP success, time to TSP, MitraClip steerable guide catheter (SGC) delivery, clip deployment, and overall procedure time. Acute adverse events were assessed. Results The TSP was successful in 100% of cases with no adverse events. The TSP time from groin access was the shortest with VLA (MN, 26.6 ± 18.5 minutes; RFN, 21.3 ± 11.9 minutes; VLA, 15.8 ± 10.0 minutes). VLA required less time to SGC delivery from TSP (MN, 18.4 ± 12.8 minutes; RFN, 9.7 ± 5.1 minutes; VLA, 5.4 ± 4.6 minutes). There were no differences in time to clip deployment between groups. Total procedure time was the lowest with VLA (MN, 138 ± 64 minutes; RFN, 123 ± 63 minutes; VLA, 96 ± 51 minutes). TSP and SGC delivery times were more consistent using VLA than those with MN ( P < .001). Conclusions Use of VLA allowed for shorter TSP times and more efficient SGC delivery into the left atrium. The choice of transseptal technique can improve overall procedure time, leading to catheterization laboratory predictability and efficiency.