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Published on: May 26, 2015
Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique
Gagan D Singh1, Jason H Rogers1, Sarah Chen2
1Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA.
Background:
During MitraClip implantation sub-valvular correction of trajectory and/or alignment may increase adverse clip or leaflet events. With systematic adjunctive use of fluoroscopy ("Parallax technique"), we aimed to assess parameters that minimize the need for corrective measures and help increase procedural efficiency.
Methods:
We retrospectively analyzed 30 patients without (Fl-) and 39 patients utilizing adjunctive fluoroscopy (Fl+) during MitraClip implantation. After establishing trajectory and supra-valvular alignment, the Parallax technique was utilized. Trajectory and alignment are maintained during advancement.
Results:
All patients had 3 or 4+ MR. There were no differences in baseline demographics. The average number of clips (Fl- vs Fl+) was 1.72 ± 0.8 vs 1.59 ± 0.5, p = .57. For the first clip, the need for sub-valvular alignment (80% vs. 36%, p = .0001), eversion with retraction back to left atrium (23% vs. 10%, p = .001) and the number of grasps (2.3 ± 1.2 vs 1.4 ± 0.9) was reduced. The time from transseptal puncture to first clip deployment (71 ± 21 vs 44 ± 16 min, p = .01) was reduced. Procedural success was achieved in all but one patient in the Fl- group (p = ns). There were no differences noted for in-hospital or 30-day outcomes.
Conclusions:
Systematic use of a simple and easy to implement "Parallax technique" was associated with reduced need for sub-valvular manipulation and was associated with improved procedural times. Further larger scale studies are needed to assess the applicability of the technique.
Insights
The Parallax technique, using adjunctive fluoroscopy during MitraClip implantation, significantly reduced the need for corrective measures and improved procedural efficiency. This fluoroscopic approach enhances alignment and reduces manipulation, leading to better outcomes.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
Background:
- Sub-valvular correction during MitraClip implantation can increase adverse events.
- Optimizing trajectory and alignment is crucial for procedural success.
Purpose of the Study:
- To assess the efficacy of the "Parallax technique" using adjunctive fluoroscopy.
- To minimize corrective measures and enhance procedural efficiency in MitraClip procedures.
Main Methods:
- Retrospective analysis of 69 patients undergoing MitraClip implantation.
- Comparison between patients without (Fl-) and with (Fl+) adjunctive fluoroscopy (Parallax technique).
- Evaluation of trajectory, alignment, and procedural parameters.
Main Results:
- The Parallax technique (Fl+) significantly reduced the need for sub-valvular alignment (36% vs. 80%) and grasps.
- Procedural times, from transseptal puncture to first clip deployment, were shorter with the Parallax technique (44 min vs. 71 min).
- No significant differences in procedural success or short-term outcomes were observed between groups.
Conclusions:
- The Parallax technique is associated with reduced sub-valvular manipulation and improved procedural times.
- This fluoroscopic approach offers a simple and effective method to enhance MitraClip procedures.
- Larger studies are recommended to further validate the technique's applicability.
