Simplified Method for Insertion of Steerable Guide into the Left Atrium Using a Pigtail Guide Wire During the MitraClip(®) Procedure: A Technical Tip.
BACKGROUND
To assess whether a new floppy pigtail guidewire provides sufficient support for introduction of the 22F-steerable guide catheter (SG) into the left atrium and is less time-consuming during the MitraClip(®) -procedure without necessity of probing and inserting a stiff wire into the pulmonary vein.


METHODS
In group 1, traditional probing of the left upper pulmonary vein and insertion of a standard stiff wire was used. In group 2, direct insertion of the floppy pigtail guidewire directly after transseptal puncture was used.


RESULTS
Patients in group 1 (n = 18) and group 2 (n = 21) did not differ significantly with respect to mitral regurgitation severity (3.2 ± 0.4 vs 3.2 ± 0.4; P = 0.814) and etiology (functional 78% vs 71%, P = 0.651). Comparing both methods, a significant reduction in time-to-SG was observed in group 2 versus group 1 (17 ± 7 minutes vs 30 ± 11 minutes; P = 0.001). The rate of crossing failures was 0% with use of the floppy pigtail guidewire as well as with the traditional technique. No complications were observed with use of the floppy pigtail guidewire.


CONCLUSIONS
Utilization of a thin, floppy pigtail guidewire for left atrium access is safe and markedly accelerates insertion of the SG for the MitraClip(®) -procedure without crossing failures of the atrial septum.
Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg.
Stefan
S
Buchner
Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg.
Ansgar
A
Dreher
Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg.
Markus
M
Resch
Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg.
Christian
C
Schach
Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg.
Christoph
C
Birner
Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg.
Andreas
A
Luchner
D000368:Aged; D054087:Atrial Septum / Q000601:surgery; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D062906:Cardiac Catheters; D057186:Comparative Effectiveness Research; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D061646:Operative Time; D011667:Pulmonary Veins / Q000601:surgery; D011677:Punctures; D012720:Severity of Illness Index; D016896:Treatment Outcome