Transaxillary Mitral Valve Repair After Failed Percutaneous Edge-to-Edge Repair

<div><p>As the execution of percutaneous edge-to-edge repair increases, so does the need for surgical treatment of failed procedures. Mitral valve surgery after failed percutaneous edge-to-edge repair can be complex and the feasibility of surgical mitral valve repair/replacement depends on the patient’s underlying systemic conditions and the time elapsing between the primary percutaneous and the secondary surgical procedures. In this setting, a minimally-invasive approach may enable complex valve surgery promoting both faster recovery and increased patient’s satisfaction (1). </p><p></p><p> </p><p>Aim of this video is to share the trans-axillary approach we adopted to repair the mitral valve in a patient who had undergone, a few days earlier, a MitraClip implantation for a severe functional mitral valve regurgitation in our Institution.</p><p> </p><p>The patient was a 64-year-old woman with a significant functional mitral valve insufficiency and a severe left ventricle disfunction (EF 25%). Due to her frailty and poor left ventricle function, we opted for a percutaneous approach through a single MitraClip (Abbott Vascular, Inc., Santa Clara, CA, USA ) implantation. Intraprocedural echocardiography showed a good result with a mild residual regurgitation without significant transvalvular gradients. However, a few days later, an echocardiogram revealed a residual severe mitral valve regurgitation due to MitraClip dislocation and posterior leaflet 2 (P2) perforation. Through a direct access transaxillary approach, the valve was repaired by removing the clip, by reconstructing the damaged posterior leaflet and by implanting a downsized semirigid complete ring (Carpentier-Edwards (CE) Physio II annuloplasty ring). The procedure was successful and the patient was uneventfully discharged seven days postoperatively.</p><p> </p><p>Reference</p><p> </p><p>1. Di Eusanio M, Berretta P, Alfonsi J, et al. Ultrafast-Track Mini Mitral Valve Repair: Direct Access Transaxillary Approach. October 2019. doi:10.25373/ctsnet.9899270</p></div>