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Published on: October 16, 2021
Debulking of the Mitral Valve: The Transseptal Approach
Tanja Kücken1, Nora Huang1, Frank Hölschermann1
1Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany; Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany.
Background:
Patients with thrombotic or infective masses on native or biological mitral valve have no established treatment if deemed ineligible for surgery. This case series summarizes our initial experience with a transseptal interventional bailout approach.
Case Summary:
Seven high-risk patients (aged 74.0 ± 4.87 years; EuroSCORE II median 14.05%) underwent transseptal debulking under cerebral protection. Six procedures used the INARI system (FlowTriever; INARI Medical) and the TriClip system (Abbott). Debulking was technically successful in all patients, without stroke, valve injury, or relevant mitral regurgitation. In 3 patients with severe mitral stenosis (gradient 23.0 ± 2.6 mm Hg), gradients were reduced by 16.6 ± 2.1 mm Hg.
Discussion:
Transseptal aspiration using large-bore catheters appears feasible and safe in selected nonsurgical candidates with mitral valve-adherent masses.
Take-Home Messages:
Transseptal aspiration of left-sided mitral valve-adherent masses is technically feasible in high-risk nonsurgical patients using large-bore steerable catheters and a cerebral protection system. This series suggests that thrombotic or infective masses on the mitral valve can be safely debulked through transseptal aspiration.
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