Electrosurgical Laceration and Stabilization of a Failed Mitral Edge-to-Edge Device Before Transcatheter Mitral Valve Replacement: The Importance of a Trans-Septal Approach

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.