Procedura percutanea combinata di riparazione dell’insufficienza mitralica con tecnica “edge-to-edge” e di chiusura dell’auricola sinistra

Gianpiero D’Amico; Tommaso Fabris; Chiara Fraccaro; Giuseppe Tarantini

doi:10.1714/3121.31040

March 1, 2019Giornale italiano di cardiologiaOpen Access

Procedura percutanea combinata di riparazione dell’insufficienza mitralica con tecnica “edge-to-edge” e di chiusura dell’auricola sinistra

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Why the study?

Patients with severe symptomatic mitral regurgitation at high surgical risk often have atrial fibrillation and contraindications to oral anticoagulation, making a combined percutaneous approach of MitraClip and left atrial appendage occlusion a potential therapeutic strategy.

Structured PICO

P

Population

1 patient with severe functional mitral regurgitation secondary to post-infarction ventricular dilation, symptomatic heart failure despite optimal medical therapy and cardiac resynchronization, and atrial fibrillation with contraindication for systemic anticoagulation due to high bleeding risk.

I

Intervention

Combined transcatheter procedure of percutaneous mitral valve repair (MVR) using the MitraClip system and left atrial appendage occlusion (LAAO).

A combined percutaneous approach for mitral valve repair and left atrial appendage occlusion may be a feasible strategy for patients with severe functional mitral regurgitation and atrial fibrillation who have contraindications to surgery and anticoagulation.

Implication

Combined MVR-LAAO may be feasible in select high-risk patients; leaves open need for prospective safety and efficacy data.

Abstract

Percutaneous mitral valve repair (MVR) using MitraClip system has been shown to be effective in patients with severe symptomatic mitral regurgitation deemed at high surgical risk. Atrial fibrillation is frequently observed in this setting, and the presence of a contraindication to oral anticoagulation is also very common in these patients. In this context, percutaneous left atrial appendage occlusion (LAAO) may be a valid alternative in reducing the thromboembolic risk. Since there is a large overlap between these two populations and the two procedures share some common steps, a combined approach of percutaneous MVR using the MitraClip system and LAAO may be considered a suitable strategy for patients with serious contraindications to both cardiac surgery and chronic antithrombotic therapy. Here we report the case of a patient affected by severe functional mitral regurgitation, secondary to post-infarction ventricular dilation, symptomatic for heart failure despite optimal medical therapy and cardiac resynchronization, and by atrial fibrillation with a contraindication for systemic anticoagulation due to high bleeding risk. Therefore, it was decided to perform a combined transcatheter procedure of MVR and LAAO.