title: Anesthesia management for MitraClip device implantation.
abstract: OBJECTIVE
  Percutaneous MitraClip implantation has been demonstrated as an alternative procedure in high-risk patients with symptomatic severe mitral regurgitation (MR) who are not suitable (or) denied mitral valve repair/replacement due to excessive co morbidity. The MitraClip implantation was performed under general anesthesia and with 3-dimensional transesophageal echocardiography (TEE) and fluoroscopic guidance.
  
  
  METHODS
  Peri-operative patient data were extracted from the electronic and paper medical records of 21 patients who underwent MitraClip implantations.
  
  
  RESULTS
  Four MitraClip implantation were performed in the catheterization laboratory; remaining 17 were performed in the hybrid operating theatre. In 2 patients, procedure was aborted, in one due to migration of the Chiari network into the left atrium and in second one, the leaflets and chords of the mitral valve torn during clipping resulting in consideration for open surgery. In the remaining 19 patients, MitraClip was implanted and the patients showed acute reduction of severe MR to mild-moderate MR. All the patients had invasive blood pressure monitoring and the initial six patients had central venous catheterization prior to the procedure. Intravenous heparin was administered after the guiding catheter was introduced through the inter-atrial septum and activated clotting time was maintained beyond 250 s throughout the procedure. Protamine was administered at the end of the procedure. All the patients were monitored in the intensive care unit after the procedure.
  
  
  CONCLUSIONS
  Percutaneous MitraClip implantation is a feasible alternative in high-risk patients with symptomatic severe MR. Anesthesia management requirements are similar to open surgical mitral valve repair or replacement. TEE plays a vital role during the MitraClip implantation.
authors.affiliation: Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
authors.forename: Harikrishnan
authors.initials: H
authors.lastname: Kothandan
authors.forename: Kian Ho
authors.initials: KH
authors.lastname: Vui
authors.forename: Vui Kian
authors.initials: VK
authors.lastname: Ho
authors.forename: Keong Yeo
authors.initials: KY
authors.lastname: Khung
authors.forename: Khung Keong
authors.initials: KK
authors.lastname: Yeo
authors.forename: Chih Hwang
authors.initials: CH
authors.lastname: Nian
authors.forename: Nian Chih
authors.initials: NC
authors.lastname: Hwang
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D012122:Ventilators, Mechanical
chemical_list: D000777:Anesthetics