Utilization of Intra Aortic Balloon Pump to Allow Mitraclip Procedure in Patients with Non-Coapting Mitral Valve Leaflets

Background: The Mitraclip procedure was designed for high-surgical risk patients with severe mitral regurgitation. Some patients do not meet the required anatomical criteria due to advanced left ventricular remodeling and mitral annular dilatation leading to leaflet tethering and insufficient coaptation surface. Theoretically "temporary remodeling" of the mitral valve apparatus, by pharmacological and/or mechanical support using intra-aortic balloon pump could improve leaflets coaptation.

Case summary: We report a case series of 4 patients with severe mitral regurgitation and non-coapting leaflets who underwent Mitraclip implantation. Sufficient coaptation was achieved only after insertion of intra-aortic balloon pump. The first patient presented with worsening heart failure and severe mitral regurgitation after a non-reperfused posterior wall MI , underwent a successful procedure with good results. The second patient presented with worsening heart failure secondary to rheumatic mitral regurgitation, and underwent Mitraclip procedure with good results after the insertion of intra-aortic balloon pump. The third patient developed worsening heart failure and severe mitral regurgitation two months after an acute inferior-lateral myocardial infarction, and underwent a successful procedure. The forth patient presented with respiratory failure, the patient underwent the procedure, but unfortunately died a few days following the procedure from multi-organ failure. In each case, the insertion of the intra-aortic balloon pump decreased annular mitral diameter and increased the coaptation surface as assessed by transesophageal echocardiography (TEE).

Discussion: For patients suffering from symptomatic severe mitral regurgitation who are not suitable candidates for MC procedure, intra-aortic balloon pump system enabled us to overcome mitral leaflet gap and complete the Mitraclip procedure successfully.