Transseptal access for MitraClip® procedures using surgical diathermy under echocardiographic guidance

Francesco Maisano, Giovanni La Canna, Azeem Latib, Cosmo Godino, Paolo Denti, Nicola Buzzatti, Maurizio Taramasso, Micaela Cioni, Andrea Giacomini, Antonio Colombo, Ottavio Alfieri

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Unlike most diagnostic procedures, the MitraClip® therapy requires precise positioning of transseptal access to ensure a successful procedure. Radiofrequency-based transseptal puncture has been developed to reduce complications and improve precision of septal access. We report our experience utilising surgical diathermy-based transseptal puncture for MitraClip implantation. Methods and results: Between October 2008 and April 2010, 72 patients underwent MitraClip therapy. Diathermy-assisted transseptal access was performed in 66 patients, under echocardiographic guidance, by manual contact of the diathermy blade with the Brockenbrough needle at the groin. Rate of successful puncture, time from femoral vein puncture to transseptal access and rate of complications were analysed. Diathermy-assisted puncture was successful in all cases. Time from femoral vein access to transseptal puncture was 16±19min. There was one suboptimal septal puncture position (too low), and there was one coronary artery air embolism. There were no cases of intraprocedural pericardial effusion or arrhythmias. Conclusions: Surgical diathermy-based transseptal puncture may be a safe and effective alternative to either conventional or RF-based septal crossing. It improves precision of the septal access and may reduce the risk of bleeding complications. This technique is now routinely used at our institution for all MitraClip procedures.

Original languageEnglish
Pages (from-to)579-586
Number of pages8
JournalEuroIntervention
Volume8
Issue number5
DOIs
Publication statusPublished - Sep 2012

Keywords

  • Diathermy
  • Electrocautery
  • MitraClip®
  • Radiofrequency
  • Structural heart interventions
  • Transseptal puncture

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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