Double Transeptal Puncture for SAPIEN M3 Transcatheter Mitral Valve Replacement: Initial Experience, Indications, and Technique

ABSTRACT The SAPIEN M3 system has been recently approved for transcatheter mitral valve replacement (TMVR). The transeptal guide sheath is used to deploy the dock, which is completely released before inserting and deploying the M3 valve using the same femoral access, transeptal puncture (TSP) and guide sheath. However, clinical scenarios such us low dock position or small left ventricular outflow tract (LVOT) may require to deploy the M3 valve with a second guide sheath while the dock is still attached to the first. In this article, we describe our initial experience with the “double transeptal technique” in two patients, focusing on indications and key technical points.