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Surgical Removal of a Detached Mitral Valve Repair Clip to Resolve Cardiogenic Shock.

ABSTRACT: Transcatheter edge-to-edge mitral valve repair (TEER) with a clip device relieves symptoms and improves outcomes in patients not suitable for open heart surgery. Here, we present a patient in whom ventricular arrhythmias developed as a result of clip embolization shortly after TEER. He underwent successful emergent surgical clip removal and mitral valve replacement. (Level of Difficulty: Advanced.).

SUBMITTER: Wedin JO

PROVIDER: S-EPMC9168778 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Surgical Removal of a Detached Mitral Valve Repair Clip to Resolve Cardiogenic Shock.

Wedin Johan O JO Karlsson Per P Holm Lovisa L Buccheri Sergio S Amin Azad A Hörsne Malmborg Jonathan J James Stefan K SK Ölander Carl-Henrik CH Strandberg Gunnar G Grinnemo Karl-Henrik KH

JACC. Case reports 20220601 11

Transcatheter edge-to-edge mitral valve repair (TEER) with a clip device relieves symptoms and improves outcomes in patients not suitable for open heart surgery. Here, we present a patient in whom ventricular arrhythmias developed as a result of clip embolization shortly after TEER. He underwent successful emergent surgical clip removal and mitral valve replacement. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 35677794

Similar Datasets

Survival Following Edge-to-Edge Transcatheter Mitral Valve Repair in Patients With Cardiogenic Shock: A Nationwide Analysis.

Project description:Background Edge-to-edge transcatheter mitral valve repair as salvage therapy in high surgical risk patients with severe mitral regurgitation presenting with cardiogenic shock (CS) has been described in small case series, but large clinical results have not been reported. This study aimed to evaluate outcomes of transcatheter mitral valve repair with MitraClip in patients with mitral regurgitation and CS using a large national database. Methods and Results From January 2014 to March 2019, we identified hospitalizations for CS in patients with mitral valve disease using data from Centers for Medicare and Medicaid Services. Those with a prior surgical or percutaneous mitral valve intervention were excluded. We compared survival between patients who underwent MitraClip during the index hospitalization and those who did not using propensity-matched analysis. The analysis included 38 166 patients (mean age, 71±11 years, 41.6% women) of whom 622 (1.6%) underwent MitraClip. MitraClip was increasingly used during CS hospitalizations over the study period (P<0.001). After matching, patients receiving MitraClip had significantly lower in-hospital mortality (odds ratio, 0.6; 95% CI, 0.47-0.77; P<0.001) and 1-year mortality (hazard ratio, 0.76; 95% CI, 0.65-0.88; P<0.001) compared with those without MitraClip. The survival benefit associated with MitraClip was consistent across subgroups of interest, with the exception of patients requiring acute mechanical circulatory support or hemodialysis at index. Conclusions In patients with mitral regurgitation presenting with CS, use of MitraClip is increasing and associated with greater in-hospital and 1-year survival. Further studies are warranted to optimize patient selection and procedure timing for those receiving MitraClip as a treatment option in CS.

| S-EPMC8174169 | biostudies-literature

Comparison of Outcomes of Edge-to-Edge Mitral Valve Repair Versus Surgical Mitral Valve Repair for Functional Mitral Regurgitation.

Project description:AimsPatients affected by functional mitral regurgitation represent an increasingly high-risk population. Edge-to-edge mitral valve repair (TEER) has emerged as a promising treatment option for these patients. However, there is limited research on the comparative outcomes of TEER versus surgical mitral valve repair (SMVr). This study seeks to compare the demographics, complications, and outcomes of TEER and SMVr based on a real-world analysis of the National Inpatient Sample (NIS) database.Methods and resultsIn the NIS database, from the years 2016 to 2018, a total of 6233 and 2524 patients who underwent SMVr and TEER were selected, respectively. The mean ages of the patients were 65.68 years (SMVr) and 78.40 years (TEER) (p < 0.01). The mortality rate of patients who received SMVr was similar to that of patients who were treated with TEER (1.7% vs. 1.9%, p = 0.603). Patients who underwent SMVr more likely suffered from perioperative complications including cardiogenic shock (2.3% vs. 0.4%, p < 0.001), cardiac arrest (1.7% vs. 1.1%, p = 0.025), and cerebrovascular infarction (0.9% vs. 0.4%, p = 0.013). The average length of hospital stay was longer (8.59 vs. 4.13 days, p < 0.001) for SMVr compared to TEER; however, the average cost of treatment was higher ($218 728.25 vs. $215 071.74, p = 0.031) for TEER compared to SMVr. Multiple logistic regression analysis showed that SMVr was associated with worse adjusted cardiogenic shock (OR, 7.347 [95% CI, 3.574-15.105]; p < 0.01) and acute kidney injury (OR, 2.793 [95% CI, 2.356-3.311]; p < 0.01).ConclusionPatients who underwent TEER demonstrated a notable decrease in postoperative complications and a shorter hospitalization period when compared to those who underwent SMVr.

| S-EPMC11228827 | biostudies-literature

LAVA-ECMO-Supported Dual-Transcatheter Aortic and Mitral Valve-in-Valve Replacement in Cardiogenic Shock.

Project description:ObjectivesMechanical circulatory support is often challenging in patients with cardiogenic shock secondary to valvular heart disease because of challenging device placement, decreased efficacy, the need for a concomitant device for left ventricular unloading, or contraindications. Left atrial venoarterial-extracorporeal membranous oxygenation (LAVA-ECMO) is an emerging technique to achieve simultaneous ventricular unloading and circulatory support unaffected by valvular disease. The use of LAVA-ECMO for high-risk transcatheter valvular replacement has not been described.Key stepsWe describe the case of a patient with cardiogenic shock resulting from dual aortic and mitral bioprosthetic degeneration who was treated with LAVA-ECMO-supported dual-transcatheter aortic and mitral valve-in-valve replacement.Potential pitfallsAmong many precautions worth mentioning, operators should be aware of the care and adjustments of the ECMO circuit required during transcatheter valvular replacement to achieve technical success without complications. The importance of a careful case planning in a multidisciplinary heart team meeting cannot be overemphasized.Take-home messageLAVA ECMO enables high-risk valvular replacement in patients in valvular cardiogenic shock.

| S-EPMC11522721 | biostudies-literature

Native mitral valve endocarditis: Robotic cardiac surgical repair.

Project description: Not available

| S-EPMC10859664 | biostudies-literature

Mitral valve repair and surgical ablation for atrial functional mitral regurgitation.

Project description:BackgroundThis observational study aimed to share our experience in the surgical management of atrial functional mitral regurgitation (AFMR).MethodsWe retrospectively identified 82 AFMR patients (63.6±7.7 years) from June 2008 to November 2018 at our institution. Of these patients, 72.0% of them were classified as NYHA functional class III/IV, and all of them had persistent AF. All patients underwent mitral valve (MV) repair, and 52 (63.4%) received concomitant surgical ablation (SA). Patients were followed up for 26.1±27.6 months, and postoperative mitral regurgitation (MR) was assessed by echocardiography.ResultsThere was no in-hospital mortality. The overall 1-year and 3-year survival rates were 97.5% and 92.9%, respectively, and 96.1% of patients recovered to NYHA functional class I/II at the latest follow-up. The left atrium (LA) diameter (P<0.001), left ventricular (LV) end-diastolic diameter (P<0.001), LV end-systolic diameter (LVESD) (P<0.001) and pulmonary artery pressure (P=0.006) significantly decreased postoperatively. The overall 1-year and 3-year freedom from recurrent MR rates were 94.3% and 65.3%, respectively, and a significant difference was found between the SA group and the non-SA group (93.8% and 93.8% vs. 95.5% and 44.2%, P=0.035). In a subgroup analysis, this significant difference was only found in the small LA group (≤60 mm).ConclusionsOur results suggest that MV repair for AFMR is safe and effective. It improves heart failure symptoms and results in reverse-remodeling of both the LA and LV. Concomitant SA might benefit patients in terms of recurrent MR, especially in the small LA group (≤60 mm).

| S-EPMC7723636 | biostudies-literature

Acute mitral valve dysfunction and cardiogenic shock due to escape of prosthetic mechanical leaflet.

Project description: Not available

| S-EPMC6960058 | biostudies-literature

Cardiogenic Shock and Mitral Valve Chord Rupture: A Rare Presentation of Libman-Sacks Endocarditis.

Project description:Distinguishing Libman-Sacks endocarditis from other valvular heart disease etiologies has important implications for management. We present a case of a 23-year-old man who presented in extremis with fever and cardiogenic shock caused by Libman-Sacks endocarditis with associated mitral valve chord rupture. (Level of Difficulty: Beginner.).

| S-EPMC8299131 | biostudies-literature

Cardiogenic Shock and Mitral Valve Chord Rupture: A Rare Presentation of Libman-Sacks Endocarditis.

| S-EPMC8299131 | biostudies-literature

Cardiogenic Shock and Mitral Valve Chord Rupture: A Rare Presentation of Libman-Sacks Endocarditis.

| S-EPMC8299131 | biostudies-literature

Percutaneous mitral valve edge-to-edge repair for late systolic anterior motion after surgical mitral valve repair: a case report.

Project description:BackgroundLate post-operative systolic anterior motion (SAM) is a rare but challenging issue. The feasibility of percutaneous mitral valve edge-to-edge repair (PMVR) using the MitraClip to treat late refractory SAM after surgical mitral valve repair has rarely been reported in the literature.Case summaryAn 88-year-old woman with a history of mitral valve repair for a P2 prolapse 14 years before, presented with signs of congestive heart failure. Transoesophageal echocardiogram (TOE) demonstrated significant SAM of the anterior mitral leaflet, resulting in the detachment from the posterior mitral leaflet in mid-to-late systole and severe mitral regurgitation (MR). The heart team decided to perform PMVR using the MitraClip to simultaneously address the issues of SAM and MR, considering the patient's high surgical risk. TOE after the clip deployment at the medial edge of the mitral valve, where the most severe SAM was detected, confirmed resolution of SAM with marked reduction of MR. The patient was discharged home with good haemodynamic compensation.DiscussionPost-operative SAM typically occurs immediately after the reparative surgery and resolves with conservative treatment; however, persistent SAM requiring repeat surgery remains a serious concern. As an alternative strategy, the MitraClip has some advantages, including low procedural risk, immediately observable results, and the ability to relocate the clip. Meanwhile, the greater risk of post-procedural mitral stenosis, particularly in patients undergoing mitral repair, should be taken into account. In our case, the clip deployment at the medial edge of the valve could minimize the progression of mitral stenosis with a satisfactory reduction of MR.

| S-EPMC8564687 | biostudies-literature

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