Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique

Abstract

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.

Reduction of radiation exposure during transcatheter edge‐to‐edge mitral valve repair

“…Additionally, adjunctive use of fluoroscopy reduces the need for sub‐valvular clip manipulation. The latter is considered to be associated with increased procedure times and adverse events 18 . Therefore, operators may be reluctant to decrease fluoroscopy pulse rate or energy in fear of inferior image quality negatively affecting the procedure.…”

“…The latter is considered to be associated with increased procedure times and adverse events. 18 Therefore, operators may be reluctant to decrease fluoroscopy pulse rate or energy in fear of inferior image quality negatively affecting the procedure. We strongly agree that the goal of reducing radiation exposure must not be pursued at the cost of procedure efficacy and safety.…”

“…After introduction of the low dose protocol, radiation dose area product dropped from 2265 to 693 [366-1231] cGy•cm 2 (p < 0.001, Table 2 and Figure 3). Concurrently, fluoroscopy time decreased from 25 to 17 [13][14][15][16][17][18][19][20][21][22][23] min (p = 0.02). Dose area product per fluoroscopy time also strongly decreased from 110 [80-140] to 38 cGy•cm 2 /min (p < 0.001), reflecting the adjustments in X-ray settings.…”