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 Rihal, Mackram Eleid

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1 Scopus citations

Abstract

Background: MitraClip is an effective transcatheter therapy for mitral regurgitation (MR). However, MitraClip is challenging in commissural MR and the optimal therapeutic approach is unclear. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)692-698
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number4
DOIs
StatePublished - Mar 1 2019

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Keywords

  • AVP II
  • commissural
  • Mitraclip
  • mitral regurgitation
  • vascular occluder

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Raphael, C. E., Malouf, J. F., Maor, E., Panaich, S. S., Pollak, P. M., Reeder, G. S., Rihal, C., & Eleid, M. (2019). A hybrid technique for treatment of commissural primary mitral regurgitation. Catheterization and Cardiovascular Interventions, 93(4), 692-698. https://doi.org/10.1002/ccd.27904