title: MitraClip® and Amplatzer® cardiac plug implantation in a single procedure: A reasonable approach?
abstract: BACKGROUND
  Percutaneous mitral valve repair using MitraClip® (MC) is a well-established method for a subset of patients with severe mitral regurgitation (MR) and high risk for surgical intervention. Amplatzer® Cardiac Plug (ACP) occludes left atrial appendage and allows the discontinuation of oral anticoagulation and prevention of thromboembolic stroke. Due to the need for femoral and transseptal access in both procedures, a single approach could lead to minor risk of further complications and shorter cumulative intervention time.
  
  
  METHODS
  We systematically analysed all four patients who underwent a combined procedure with MC and ACP in our heart-centre. All procedures were performed under fluoroscopic as well as echocardiographic guidance, and follow-up controls in a midterm period were carried out.
  
  
  RESULTS
  In all patients (2 male/female; age 73-88years), MC (1-2 Clips) and ACP (size 18-28mm) were successfully implanted in one procedure (mean total time: 114±17min). At least moderate MR was achieved and two patients had no complications and therefore were discharged early. In a third patient, a dislocation of ACP occurred 2h after the implantation. The oldest patient developed a respiratory insufficiency due to cardiac decompensation and further complications.
  
  
  CONCLUSIONS
  A combination of MC and ACP in a single procedure was feasible in this first case series of patients without a significant extension of procedure time. However, it might be important to select patients carefully. The location of optimal transseptal puncture may be challenging in regard to ACP placement, even in experienced hands and subsequent complications can occur.
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Goettingen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Tichelbäcker
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Goettingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Puls
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Goettingen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Jacobshagen
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Goettingen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Hasenfuß
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Goettingen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Schillinger
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Goettingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hünlich
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Goettingen, Germany. Electronic address: mschroeter@med.uni-goettingen.de.
authors.forename: M R
authors.initials: MR
authors.lastname: Schroeter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D055989:Septal Occluder Device / Q000706:statistics & numerical data; D013525:Surgical Instruments / Q000706:statistics & numerical data
keywords: Atrial fibrillation; Combined procedure; Interventional therapy; LAA occlusion; Mitral valve regurgitation