Never Give Up: Deep Hypothermic Circulatory Arrest for Transcatheter Mitral Edge-To-Edge Repair Failure in Porcelain...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter edge-to-edge mitral valve repair (TEER) is a minimally invasive option for mitral regurgitation.
• Previous cardiac surgery and porcelain aorta present significant challenges for repeat interventions.
• Device malapposition in TEER can lead to recurrent or new-onset severe mitral regurgitation.

Observation:

• A 79-year-old patient with a history of prior cardiac surgery experienced severe mitral regurgitation post-TEER due to single leaflet device attachment.
• The patient exhibited a high surgical risk profile, including a porcelain aorta, but maintained good physical and cognitive function.
• Despite the risks, the patient was deemed operable for surgical mitral valve replacement.

Findings:

• Mitral valve replacement with a bioprosthesis was successfully performed using deep hypothermic circulatory arrest and retrograde cerebral perfusion.
• The patient experienced a regular postoperative course.
• At one-year follow-up, the patient remained in good functional class.

Implications:

• Surgical mitral valve replacement remains a viable option for managing TEER failure, even in high-risk patients.
• Careful patient selection, considering functional status, is crucial for successful complex cardiac interventions.
• Advanced surgical techniques, including circulatory arrest and cerebral perfusion, can mitigate risks in complex aortic and cardiac cases.