Transcatheter Procedure for Residual Mitral Regurgitation After MitraClip Implantation Using Amplatzer Duct Occluder II

• Published in: JACC. Cardiovascular interventions 2016-06, Vol.9 (12), p.1280-1288
• Main Authors: Kubo, Shunsuke, MD, Cox, Justin M., MD, Mizutani, Yukiko, MD, Uberoi, Abhimanyu, MD, Chakravarty, Tarun, MD, Nakajima, Yoshifumi, MD, Hussaini, Asma, PA, Tat, Emily, BA, Makar, Moody, MD, Kar, Saibal, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amplatzer Duct Occluder II; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiovascular; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; edge-to-edge mitral valve repair; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Hemodynamics; Humans; Male; mitral regurgitation; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - therapy; Prosthesis Design; Radiography, Interventional; Retreatment; Septal Occluder Device; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2016.03.011

Abstract Objectives This study reports a novel transcatheter procedure for residual mitral regurgitation (MR) after MitraClip implantation using the Amplatzer Duct Occluder II (ADO II). Background Although the MitraClip procedure is a transcatheter treatment option for patients at high surgical risk with severe MR, management of significant residual MR after MitraClip implantation is still challenging. Methods We describe a case series of 9 consecutive patients who underwent transcatheter deployment of the ADO II plug for significant residual MR after MitraClip implantation from April to October 2015. Results The mean age was 79.3 ± 11.4 years. The deployment of the ADO II plug was performed at the initial MitraClip procedure in 7 patients and at the second procedure for recurrent symptoms in 2 patients. There were 2 types of residual MR seen after MitraClip implantation: residual commissural MR (n = 3) and residual intraclip MR (n = 6). The ADO II was successfully deployed with significant reduction of MR flow and left atrial pressure in all patients. The ADO II plug was retrieved in 1 patient because of device embolization to the ostial right coronary artery. However, all patients were discharged 1.8 ± 1.2 days after the procedure, with no significant MR on pre-discharge transthoracic echocardiography. In 8 patients who underwent 1-month symptomatic assessment, clinical symptoms were diminished to New York Heart Association functional class I or II. Conclusions Transcatheter deployment of the ADO II plug was effective for the reduction of residual commissural MR and intraclip MR after MitraClip implantation. The potential role of this technique should be established for challenging cases.