Key result
MitraClip at the time of TAVR successfully treated systolic anterior motion and stabilized LVOT gradients in a patient with severe aortic stenosis.
Why the study?
Patients with concomitant severe AS and LVOT obstruction undergoing TAVR are at risk for hemodynamic collapse due to worsening LVOT obstruction from a sudden decrease in afterload.
Does MitraClip at the time of TAVR prevent hemodynamic complications in patients with significant LVOT obstruction secondary to SAM and AS?
Case Report (n=1)
Does MitraClip at the time of TAVR prevent hemodynamic complications in patients with significant LVOT obstruction secondary to SAM and AS?
MitraClip at the time of TAVR may represent a feasible option to prevent hemodynamic complications in patients with significant LVOT obstruction secondary to SAM and severe AS.
May stabilize hemodynamics with MitraClip at TAVR in AS with LVOT obstruction; hypothesis-generating, needs randomized trials.
Patients with concomitant severe aortic stenosis (AS) and left ventricular outflow tract (LVOT) obstruction undergoing transcatheter aortic valve replacement (TAVR) are at risk for hemodynamic collapse due to a sudden decrease in afterload causing worsening LVOT obstruction. We present a case of an 88-year-old female with symptomatic, severe AS, and LVOT obstruction with systolic anterior motion (SAM) of the mitral leaflet in whom alcohol septal ablation was contraindicated secondary to a chronic total occlusion of the right coronary artery that filled retrograde via septal collaterals. MitraClip at the time of TAVR was successfully performed to treat SAM with subsequent stabilization of LVOT gradients despite treatment of the patient's AS. This novel approach may represent a feasible option to prevent hemodynamic complications after TAVR in patients with significant LVOT obstruction secondary to SAM and AS.
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Bode et al. (2020) conducted a case report in Severe aortic stenosis and left ventricular outflow tract obstruction with systolic anterior motion (n=1). MitraClip was evaluated on Treatment of systolic anterior motion and stabilization of LVOT gradients. MitraClip at the time of TAVR successfully treated systolic anterior motion and stabilized LVOT gradients in a patient with severe aortic stenosis.
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