Key result
Trans-septal ELASTA was successfully performed after transapical ELASTA failed due to possible wire impingement in the PASCAL device, allowing subsequent transapical Tendyne implantation.
Why the study?
ELASTA-Clip has been proposed to cut the anterior mitral leaflet with a suggested simplified transapical approach, but clinical experience with failed edge-to-edge devices remains limited.
Case Report (n=1)
Transfemoral/trans-septal ELASTA should be preferred over a transapical approach for failed edge-to-edge mitral devices to avoid wire impingement.
Demonstrates trans-septal ELASTA feasibility after transapical failure; hypothesis-generating for access choice in failed edge-to-edge cases and requires validation.
BACKGROUND: Electrosurgical laceration and stabilization of failed MitraClip(s) (ELASTA-Clip) has been proposed as a novel technique to cut the anterior mitral leaflet. A simplified transapical approach has been suggested. CASE SUMMARY: An 83-year-old man was admitted for recurrent, symptomatic mitral regurgitation after edge-to-edge (ETE) repair with PASCAL due to incomplete closure of the device. A transapical ELASTA failed despite multiple attempts. The procedure was then switched trans-septally and successfully performed without interference with the device. A transapical Tendyne was then implanted without any issue. DISCUSSION: The case highlights that ELASTA can fail in case of transapical approach for possible wire impingement in the PASCAL. TAKE-HOME MESSAGE: Transfemoral ELASTA should be preferred particularly in case of failed ETE due to partial closure of the ETE device.
No takes yet. Share an insight, caveat, or question.
Mangieri et al. (2025) conducted a case report in Recurrent, symptomatic mitral regurgitation after edge-to-edge repair (n=1). Trans-septal ELASTA vs. Transapical ELASTA was evaluated on Procedural success. Trans-septal ELASTA was successfully performed after transapical ELASTA failed due to possible wire impingement in the PASCAL device, allowing subsequent transapical Tendyne implantation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: