Transcatheter mitral valve repair toward a surgical standard: direct annuloplasty with a Cardioband device to treat severe residual mitral regurgitation after MitraClip

We describe the clinical experience of treatment severe residual mitral regurgitation (MR) using CardioBand, transcatheter direct annuloplasty system, after transcatheter leaflet repair with MitraClip. The patient was an 85-year-old man with severe ischemic MR. The EuroSCORE II–estimated risk of operative mortality was 11.9%. He was admitted in New York Heart Association functional class ll one year after MitraClip therapy and had chronic kidney disease (creatinine 1.98 mg/dL, glomerular filtration rate 31 mL/min). He had a clinical history of permanent atrial fibrillation, prior coronary artery bypass surgery. Transthoracic echocardiography (TTE) revealed grade 4+ recurrent MR, impaired left ventricular (LV) systolic function with akinesia of LV posterior wall.

The intervention was performed under general anesthesia, fluoroscopy, as well as transesophageal echocardiography (TEE) guidance. The Cardioband delivery system was inserted through into the left atrium by transfemoral transseptal approach. Following the first anchor implantation in the lateral commissure, additional anchors were implanted along the posterior annulus until reaching the medial commissure. After that, using a size adjustment tool, mitral annulus was cinched under TEE guidance. MR was reduced from severe to mild, with a corresponding decrease in mitral annulus area (10.8 to 6.16 cm²). Finally, iatrogenic atrial septal defect was occluded. At 6-month follow-up, the patient was in good functional status without symptoms.

This case demonstrates the feasibility and safety of the percutaneous remodeling of the MV by implanting the Cardioband device for residual MR after MitraClip, associated with reduction in annular dimensions and MR severity. ​