Anaesthetic management of severe mitral regurgitation using transcatheter mitral valve repair with mitra clip

Introduction: Transcatheter mitral valve repair using the MitraClip system is a minimally invasive option for patients with severe mitral regurgitation (MR) who are at high risk for conventional surgery. This case report describes the perioperative anaesthetic challenges and management strategies in an extreme-risk patient undergoing this procedure.Case Description: An 86-year-old man with coronary artery disease, chronic kidney disease, hypertension, diabetes mellitus, and symptomatic moderate-to-severe MR presented for intervention. His preoperative Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score was 47.6%, indicating prohibitive surgical risk. The MitraClip procedure was performed via the right femoral vein under general anaesthesia with transoesophageal echocardiography (TEE) and fluoroscopic guidance. Invasive blood pressure monitoring, central venous catheterization, and careful fluid management were used to maintain haemodynamic stability. Intravenous heparin was administered after transseptal puncture, and activated clotting time was maintained above 300 seconds. Protamine was given at the end of the procedure. Following clip deployment, severe MR was reduced to mild (vena contracta 2 mm, effective regurgitant orifice area 0.1 cm², regurgitant volume 20 mL).Conclusion: MitraClip implantation is a safe and effective alternative for high-risk patients with severe MR who are not candidates for surgery. Success requires a tailored anaesthetic approach including haemodynamic stability, skilled TEE guidance, vigilant monitoring, and prompt management of potential complications.