Debulking of the Mitral Valve

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.