A hybrid technique for treatment of commissural primary mitral regurgitation

Claire E Raphael; Joseph F Malouf; Elad Maor; Sidakpal S Panaich; Peter M Pollak; Guy S Reeder; Charanjit S Rihal; Mackram F Eleid

doi:10.1002/ccd.27904

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A hybrid technique for treatment of commissural primary mitral regurgitation

Journal article

Peer reviewed

A hybrid technique for treatment of commissural primary mitral regurgitation

Claire E Raphael, Joseph F Malouf, Elad Maor, Sidakpal S Panaich, Peter M Pollak, Guy S Reeder, Charanjit S Rihal and Mackram F Eleid

Catheterization and cardiovascular interventions, Vol.93(4), pp.692-698

03/01/2019

DOI: 10.1002/ccd.27904

PMID: 30244543

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Abstract

MitraClip is an effective transcatheter therapy for mitral regurgitation (MR). However, MitraClip is challenging in commissural MR and the optimal therapeutic approach is unclear. We describe a case series of six consecutive patients with severe commissural primary mitral regurgitation who underwent MitraClip insertion followed by an Amplatzer Vascular Plug (AVP) II occluder between the commissure and the MitraClip. The procedure was successful in all patients. MR was reduced from severe to mild/trivial in 50% and moderate in 50% of cases. On 30-day follow-up, NYHA class had improved from III (6 patients) to I (2 patients), II (2 patients), and III (2 patients). The mean transmitral gradient was 2.5 ± 1.8 mmHg at baseline and 4.8 ± 2.6 mmHg following the procedure. One patient developed hemolysis immediately post procedure. The other five patients remained well during a median follow-up of 20 months (range 5-50 months) with no reported device dislodgement. Elective treatment of severe commissural MR with a laterally or medially placed MitraClip coupled with an AVP II occluder between the clip and the commissure is feasible and safe. This approach may provide a useful management alternative in selected patients.

Severity of Illness Index

Heart Valve Prosthesis Implantation - instrumentation

Mitral Valve Insufficiency - surgery

Heart Valve Prosthesis

Humans

Cardiac Catheterization - adverse effects

Male

Mitral Valve - surgery

Treatment Outcome

Prosthesis Design

Cardiac Catheterization - instrumentation

Mitral Valve - physiopathology

Recovery of Function

Mitral Valve - diagnostic imaging

Time Factors

Heart Valve Prosthesis Implantation - adverse effects

Aged, 80 and over

Female

Aged

Mitral Valve Insufficiency - diagnostic imaging

Hemodynamics

Mitral Valve Insufficiency - physiopathology

Details

Title: Subtitle: A hybrid technique for treatment of commissural primary mitral regurgitation
Creators: Claire E Raphael - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Joseph F Malouf - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Elad Maor - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Sidakpal S Panaich - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Peter M Pollak - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Guy S Reeder - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Charanjit S Rihal - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Mackram F Eleid - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Resource Type: Journal article
Publication Details: Catheterization and cardiovascular interventions, Vol.93(4), pp.692-698
DOI: 10.1002/ccd.27904
PMID: 30244543
ISSN: 1522-1946
eISSN: 1522-726X
Language: English
Date published: 03/01/2019
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094399602771

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