Transapical mitral valve implantation after unclipping of a MitraClip: a glimpse into the future and treatment considerations in mitral regurgitation.
OBJECTIVE
Transcatheter mitral valve implantation (TMVI) is a novel approach that may enable a less invasive effective reduction of mitral regurgitation (MR). A limitation of the MitraClip is that definitive implantation of a clip precludes future therapy with TMVI. The purpose of this paper is to describe contemporary treatment considerations in patients with mitral valve regurgitation.


RESULTS
In this report we describe an attempted MitraClip implantation which resulted in no reduction of MR severity. There was a consensus that additional clips would probably not be effective. MitraClip implantation was therefore abandoned and the clip was removed, allowing subsequent successful TMVI with the Tiara™ system three weeks later. Echocardiography revealed secure seating of the prosthesis with good mitral valve function, trivial paravalvular leakage and transvalvular gradient of 3 mmHg. The patient recovered rapidly and was discharged four days post implant.


CONCLUSIONS
The clinical approach towards high-risk patients with significant MR may change in the next few years. In selected patients, in whom an initial attempt with MitraClip implantation results in only limited efficacy, the clip may be retrieved during the index procedure to allow subsequent TMVI.
St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
Danny
D
Dvir
Anson
A
Cheung
Robert
R
Boone
Jonathon
J
Leipsic
Philipp
P
Blanke
Gidon
G
Perlman
Robert
R
Moss
Mustafa
M
Toma
Dion
D
Stub
Shmuel
S
Banai
John
J
Webb
D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects; D017548:Echocardiography, Transesophageal / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000628:therapy*; D018579:Patient Selection; D011474:Prosthesis Design / Q000379:methods; D012306:Risk; D013525:Surgical Instruments / Q000009:adverse effects; D016896:Treatment Outcome