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Surgical revision of failed MitraClip procedure for atrial functional mitral regurgitation

Yu Inaba1, Yasunori Iida2, Hidetoshi Oka2

  • 1Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Yokohama City, Kanagawa, 230-8765, Japan. yuys4223@gmail.com.

Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs
|May 31, 2021
PubMed

Insights

MitraClip treatment for atrial functional mitral regurgitation (aFMR) in patients with annular dilatation can lead to complications like single leaflet device attachment. Careful consideration is needed due to potential adverse events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe mitral regurgitation (MR) often necessitates intervention, with the MitraClip system offering a less invasive option for high-risk patients.
  • Atrial functional MR (aFMR) presents unique challenges, and the acute outcomes of MitraClip treatment in these cases are not well-documented.
  • Mitral annular dilatation and failed leaflet adaptation are specific anatomical factors that may influence MitraClip device success.

Observation:

  • A rare case of an 80-year-old woman with aFMR, mitral annular dilatation, and failed leaflet adaptation treated with MitraClip is presented.
  • The patient experienced acute complications, including single leaflet device attachment (SLDA) and posterior leaflet injury, three days post-procedure.
  • The patient subsequently underwent successful mitral valve replacement surgery.

Findings:

  • The MitraClip procedure in this specific aFMR case resulted in SLDA and leaflet injury, highlighting potential risks.
  • Mitral valve replacement was successfully performed, resolving the acute complications.
  • Post-replacement, significant improvement in pulmonary hypertension and reduction in left atrial volume were observed.

Implications:

  • The MitraClip system requires careful application in patients with aFMR, particularly those with mitral annular dilatation and failed leaflet adaptation.
  • Clinicians should be vigilant for potential complications like SLDA when using MitraClip in complex aFMR cases.
  • Successful surgical revision (mitral valve replacement) can effectively manage MitraClip-related complications and improve hemodynamic parameters.
Keywords:
MitraClipMitral valve regurgitationSingle leaflet device attachment

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