Mitral valve replacement following a failed MitraClip procedure

While mitral valve surgery remains the gold standard for mitral regurgitation (MR), recent innovative and less invasive procedures like percutaneous MitraClip insertion make treatment options open to patients with end-stage dilated cardiomyopathy and poor left ventricular function, since such a coho...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2012-10, Vol.42 (4), p.739-740
Main Authors: Chanda, Binayak, Venn, Graham E.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiac Surgical Procedures - instrumentation
Cardiology. Vascular system
Cardiomyopathy, Dilated - complications
Device Removal
Equipment Failure
Heart
Heart Valve Prosthesis Implantation
Humans
Male
Medical sciences
Middle Aged
Mitral Valve - surgery
Mitral Valve Insufficiency - etiology
Mitral Valve Insufficiency - surgery
Myocarditis. Cardiomyopathies
Pneumology
Reoperation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
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Summary:While mitral valve surgery remains the gold standard for mitral regurgitation (MR), recent innovative and less invasive procedures like percutaneous MitraClip insertion make treatment options open to patients with end-stage dilated cardiomyopathy and poor left ventricular function, since such a cohort of patients invariably represents a high surgical risk. Enthusiasts of this procedure advocate the use of MitraClip as a primary procedure for patients with Type 1 MR and end-stage cardiomyopathy. Valve repair could be reserved for those patients with ongoing regurgitation following MitraClip insertion. We describe a patient treated by MitraClip insertion in whom the unsuccessful mid-term result necessitated surgery. In this patient, damage to the mitral valve from the MitraClip insertion produced a central leaflet perforation, which precluded repair, and thereby, the patient received a mechanical valve replacement. The enthusiasm for a less invasive initial approach in such patients must be balanced against the risk of failure of the primary procedure so that the patient is not denied the prospect of repair in the first instance.
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezs302