Transaxillary Mitral Valve Repair After Failed Percutaneous Edge-to-Edge Repair
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).
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.
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.
Reference
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
