Simplified Method for Insertion of Steerable Guide into the Left Atrium Using a Pigtail Guide Wire During the MitraClip(®) Procedure: A Technical Tip

J Interv Cardiol. 2015 Oct;28(5):472-8. doi: 10.1111/joic.12224. Epub 2015 Sep 8.

Abstract

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.

MeSH terms

  • Aged
  • Atrial Septum / surgery
  • Cardiac Catheterization* / instrumentation
  • Cardiac Catheterization* / methods
  • Cardiac Catheters*
  • Comparative Effectiveness Research
  • Female
  • Heart Atria / surgery*
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Annuloplasty / methods*
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / surgery*
  • Operative Time
  • Pulmonary Veins / surgery
  • Punctures
  • Severity of Illness Index
  • Treatment Outcome