“…A trans-apical approach is also feasible, with the benefit of allowing direct entry of the mitral PVL regardless of its location; this can be performed percutaneously or open [2]. Disadvantages to a percutaneous apical approach are that it is more invasive and requires additional pre-procedure planning and imaging (i.e., ultrasound, echocardiography, and/ or computed tomography) and that there is limited availability of dedicated apical closure devices domestically or internationally [5][6][7]. The open approach has additional limitations, such as an increased risk of apical tear, bleeding, myocardial damage, arrhythmia, coronary damage, and infection.…”