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

BackgroundTo 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((R))-procedure without necessity of probing and inserting a stiff wire into the pulmonary vein. MethodsIn 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. ResultsPatients in group 1 (n=18) and group 2 (n=21) did not differ significantly with respect to mitral regurgitation severity (3.20.4 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. ConclusionsUtilization of a thin, floppy pigtail guidewire for left atrium access is safe and markedly accelerates insertion of the SG for the MitraClip((R))-procedure without crossing failures of the atrial septum. (J Interven Cardiol 2015;28:472-478)