The ELASTA-T Technique for TTVR After Failed T-TEER: An Operator-Oriented Guide to Planning, Execution, Pitfalls

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Structural Heart Disease

Background:

• Failure of tricuspid transcatheter edge-to-edge repair (T-TEER) leading to persistent severe tricuspid regurgitation (TR) is a growing clinical challenge.
• Transcatheter tricuspid valve replacement (TTVR) is an emerging solution for recurrent TR post-T-TEER, but pre-existing devices complicate the procedure.
• Existing T-TEER devices alter tricuspid valve geometry, hindering coaxial crossing, symmetrical expansion, and proper anchoring for TTVR.

Purpose of the Study:

• To present a practical, operator-focused technical framework for the ELASTA-T technique.
• To describe the ELASTA-T procedure as a method to prepare the tricuspid valve anatomy prior to TTVR in patients with failed T-TEER.
• To facilitate the adoption of this novel technique for structural heart operators.

Main Methods:

• The ELASTA-T technique involves electrosurgical laceration and stabilization of T-TEER devices.
• A structured approach includes preprocedural planning (T-TEER device position, leaflet geometry, subvalvular anatomy).
• Procedural steps include dual-catheter crossing, snaring, electrosurgical wire preparation, controlled leaflet laceration, and TTVR deployment using the EVOQUE system.

Main Results:

• The ELASTA-T technique aims to restore a functionally single-orifice configuration by selectively detaching one leaflet from the T-TEER device.
• This preparation optimizes conditions for subsequent TTVR device implantation.
• The paper discusses key technical considerations, potential pitfalls, and troubleshooting strategies to enhance safety and reproducibility.

Conclusions:

• ELASTA-T is a novel catheter-based strategy to address anatomical challenges posed by failed T-TEER devices before TTVR.
• This technique aims to improve the safety and efficacy of TTVR in a complex patient subset.
• Structured guidance and understanding of potential issues are crucial for successful implementation and wider adoption.