Marianna Adamo1, Salvatore Curello1, Ermanna Chiari2, Claudia Fiorina1, Giuliano Chizzola1, Marco Magatelli1, Elisa Locantore1, Giovanni Cuminetti1, Carlo Lombardi2, Aldo Manzato3, Marco Metra2, Federica Ettori4. 1. Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy. 2. Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili, Brescia, Italy. 3. Division of Cardiothoracic Anaesthesiology, Cardiothoracic Department, Spedali Civili, Brescia, Italy. 4. Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy. Electronic address: fedettori@libero.it.
Abstract
BACKGROUND: Limited evidence is available about MitraClip therapy in patients with acute mitral regurgitation (MR) complicating myocardial infarction (MI). METHODS AND 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.
BACKGROUND: Limited evidence is available about MitraClip therapy in patients with acute mitral regurgitation (MR) complicating myocardial infarction (MI). METHODS AND 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: Dan Haberman; Rodrigo Estévez-Loureiro; Tomas Benito-Gonzalez; Paolo Denti; Dabit Arzamendi; Marianna Adamo; Xavier Freixa; Luis Nombela-Franco; Pedro Villablanca; Lian Krivoshei; Neil Fam; Konstantinos Spargias; Andrew Czarnecki; Isaac Pascual; Fabien Praz; Doron Sudarsky; Arthur Kerner; Vlasis Ninios; Marco Gennari; Ronen Beeri; Leor Perl; Haim Danenberg; Lion Poles; Sara Shimoni; Sorel Goland; Berenice Caneiro-Queija; Salvatore Scianna; Igal Moaraf; Davide Schiavi; Claudia Scardino; Noé Corpataux; Julio Echarte-Morales; Michael Chrissoheris; Estefanía Fernández-Peregrina; Mattia Di Pasquale; Ander Regueiro; Carlos Vergara-Uzcategui; Andres Iñiguez-Romo; Felipe Fernández-Vázquez; Danny Dvir; Maurizio Taramasso; Mony Shuvy Journal: J Clin Med Date: 2021-04-22 Impact factor: 4.241
Authors: Leor Perl; Tamir Bental; Katia Orvin; Hana Vaknin-Assa; Gabriel Greenberg; Pablo Codner; Yaron Shapira; Mordehay Vaturi; Alexander Sagie; Ran Kornowski Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: Rodrigo Estévez-Loureiro; Marta Tavares Da Silva; José Antonio Baz-Alonso; Berenice Caneiro-Queija; Manuel Barreiro-Pérez; Francisco Calvo-Iglesias; Rocio González-Ferreiro; Luis Puga; Miguel Piñón; Andrés Íñiguez-Romo Journal: Front Cardiovasc Med Date: 2022-09-23