Salvage MitraClip in Severe Functional Mitral Regurgitation Complicating Acute Myocardial Infarction – Data from the Israeli Mitraclip Registry (IMCR)
2Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School
3Heart Institute, HaEmek Medical Center, Rappaport School of Medicine
4Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine
5Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University
6Department of Cardiology, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University.
7Department of Cardiology, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev
8Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Sackler Faculty of Medicine
9Heart Institute, Hadassah-Hebrew University Medical Centre
Introduction: The role of the MitraClip implantation in the treatment of acute functional mitral regurgitation (FMR) complicating acute myocardial infarction (MI) in undetermined.
Methods: The IMCR is a multicenter retrospective registry, involving 9 sites in Israel, collects data on all patients who underwent MitraClip procedure in Israel since January 2011.
We included patients who developed acute severe functional MR (FMR) within 90 days of acute MI with no evidence for structural valvular damage. All patents were hospitalized in class IV Heart failure (NYHA) and required intervenous diuretics.
We evaluated immediate, 30-day and intermediate term outcomes in those patients.
Results: From January 2011 to September 2018, a total of 558 patients were treated with MitraClip system in Israel. Eight patients (1.4%) were identified as being treated for FMR in the setting of acute MI.
Patients’ mean age was 68.1 ± 7.7 years, there were 5 women and 3 men. 6 out of 8 were presented with ST elevation myocardial infarction (STEMI), more than half of the patients (5 of 8) had Inferior wall MI. In all cases left circumflex was the infarct related artery.
All patients had severe MR (4+) and NYHA class 4 requiring IV diuretics, half of the patients were supported by intra-aortic balloon pump (IABP).
MitraClip procedure was performed 34±21 days after MI presentation. One to three clips were implanted. The acute success rate was 87.5 %, MR was reduced to 2±0.9 post procedure with significant reduction in both V-wave and pulmonary artery (PA) Pressures. One patients died after conversion to mitral valve surgery due to valve annular rapture. All other patients were discharged and well after 30 days.
Conclusions: MitraClip therapy could serve as salvage procedure for critically ill patients with acute severe FMR after recent MI.
Powered by Eventact EMS