Percutaneous edge-to-edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: A single centre experience

• Published in: International journal of cardiology Vol. 234; pp. 53 - 57
• Main Authors: Adamo, Marianna, Curello, Salvatore, Chiari, Ermanna, Fiorina, Claudia, Chizzola, Giuliano, Magatelli, Marco, Locantore, Elisa, Cuminetti, Giovanni, Lombardi, Carlo, Manzato, Aldo, Metra, Marco, Ettori, Federica
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2017
• Subjects: Acute Disease; Acute myocardial infarction; Aged; Aged, 80 and over; Cardiac Surgical Procedures - methods; Cardiovascular; Female; Follow-Up Studies; Hemodynamics; Humans; Ischemic mitral regurgitation; Italy; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Mitral valve repair; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Pulmonary Edema - etiology; Pulmonary Edema - therapy; Risk Assessment; Severity of Illness Index; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Treatment Outcome; Acute myocardial infarction; Ischemic mitral regurgitation; Mitral valve repair
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.02.072

Abstract Background Limited evidence is available about MitraClip therapy in patients with acute mitral regurgitation (MR) complicating myocardial infarction (MI). Methods and results Among 80 consecutive patients undergoing MitraClip treatment, 5 (6.3%) had been admitted for acute MI complicated by severe MR. Mean age was 73 ± 6 years and 3 were males. At the time of admission they were in cardiogenic shock (80%) or pulmonary oedema (20%), with severe MR, left ventricular dysfunction and pulmonary hypertension. The indication to MitraClip treatment was based on severe hemodynamic instability with dependence on intravenous therapy and mechanical supports despite percutaneous coronary revascularization and on high surgical risk of 27.1 ± 13% and 10.2 ± 6% using Euroscore II and STS score respectively. MitraClip procedure was performed at 53 ± 33 days from admission. One or two clips were employed in 2 and 3 patients respectively. Procedural success (MR ≤ 2 +) was achieved in all patients without complications and with successful weaning from mechanical supports and intravenous drugs in all but one patient who underwent left ventricular assist device implantation at 60 days from MitraClip procedure. MR recurrence occurred at 30-day follow-up in one patient who had concomitant aortic regurgitation. One patient died during follow-up for non-cardiovascular cause. However, recovery of hemodynamic balance with significant and persistent pulmonary pressure reduction and functional status improvement up to 2-year follow-up was observed in most of the patients. Conclusions Critical patients with acute ischemic MR post-MI with persistence of hemodynamic instability after coronary revascularization may benefit from MitraClip therapy acutely with favourable long-term follow-up results.