title: Percutaneous edge-to-edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: A single centre experience.
abstract: BACKGROUND
  Limited evidence is available about MitraClip therapy in patients with acute mitral regurgitation (MR) complicating myocardial infarction (MI).
  
  
  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±6years 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±33days 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 60days 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.
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Adamo
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Curello
authors.affiliation: Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Ermanna
authors.initials: E
authors.lastname: Chiari
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Chizzola
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Magatelli
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Locantore
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cuminetti
authors.affiliation: Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Division of Cardiothoracic Anaesthesiology, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Manzato
authors.affiliation: Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy. Electronic address: fedettori@libero.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Ischemic mitral regurgitation; Mitral valve repair