Transjugular mitral valve repair with the MitraClip: A step‐by‐step guide

• Published in: Catheterization and cardiovascular interventions 2020-09, Vol.96 (3), p.699-705
• Main Authors: Yap, Jonathan, Chen, Sarah, Smith, Thomas W. R., Rogers, Jason H., Singh, Gagan D.
• Format: Article
• Language: English
• Subjects: Cardiac Catheterization - instrumentation; Catheterization, Central Venous; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - instrumentation; Humans; Jugular Veins - diagnostic imaging; Male; Middle Aged; Mitral valve; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Annuloplasty - instrumentation; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; mitral valve repair; Recovery of Function; Reoperation; transjugular; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28902

The MitraClip procedure is carried out almost exclusively via the transfemoral approach. However, in some patients transfemoral delivery of MitraClip is not technically feasible (e.g., occluded inferior vena cava or tortuous/obstructive iliofemoral venous anatomy). The technical considerations and challenges of the MitraClip procedure are amplified when an alternate route is considered. We describe a successful case of MitraClip performed via the right internal jugular (IJ) approach in a patient with a flail A3 scallop and previous mitral valve repair. We reviewed prior cases in the literature and discuss step‐by‐step the pertinent clinical and technical considerations for performing this procedure via the transjugular route. In summary, the right IJ access site provides a reasonable alternative to perform the MitraClip procedure in cases where femoral access is contraindicated or prohibitive. A thorough understanding of the technical considerations is crucial in improving procedural success rates.