[New transcatheter strategies for multiple pathologies: a paradigmatic clinical case]

Percutaneous transcatheter left atrial appendage occlusion and transcatheter mitral valve repair with the MitraClip system represent new therapeutic strategies for selected patients at high risk for both hemorrhagic and cardioembolic events or with symptomatic heart failure and moderate-to-severe mitral valve regurgitation, respectively. We report the case of an 84-year-old patient with severe degenerative mitral regurgitation hospitalized for a first episode of atrial fibrillation, angina pectoris and heart failure. The patient presented a clinical history of spontaneous cerebral bleeding, severe three-vessel coronary disease and multiple comorbidities that contraindicated a conventional surgical treatment. After an accurate clinical-instrumental evaluation, the local Heart Team indicated a combined procedure of percutaneous left atrial appendage closure and transcatheter mitral valve repair with the MitraClip system, followed by multivessel percutaneous coronary intervention (PCI) with drug-eluting stent implantation. Dual antiplatelet treatment was prescribed for 12 months after PCI.