Left Ventricular Assist Device Implantation Following Percutaneous Mitraclip Procedure

Tanıl Ozer, Ozge Altas Yerlikhan, Mustafa Mert Ozgur, Mustafa Karaaslan, Mehmet Aksut, Sabit Sarikaya, Kaan Kirali

University of Health Sciences Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–A

Abstract

Introduction:

Mitraclip implantation is becoming an alternative treatment option in patients with severe mitral regurgitation and impaired left ventricular function. We reported a 55-years-old male patient who underwent LVAD implantation ten months after mitraclip intervention.

Case and Operative Technique

The patients ‘ejection fraction was 20%. His clinic condition had worsened progressively after mitraclip implantation. Lvad implantation or heart transplantation were the only chances for patient. We decided to perform lvad implantation but previous mitraclip implantation causing mitral stenosis was impairing ventricular filling so we decided to remove clips.

Left anterolateral thoracotomy was performed to sew LVAD ring on to ventricule, a cylindrical blade was used to excise a core from apical myocardium. Then ventricle was inspected for thrombus or residue component. The patient had two clips causing reduction in valve area. Consequently, one clip was removed to increase the area and increase diastolic ventricular filling. We also performed atrial septal defect primer closure and tricuspid ring annuloplasty. Control TEE showed adequate mitral valve area and ventricular filling and there was no suction. And the outflow graft was tunneled through pleural cavity to ascending aorta. Patient discharged from hospital two weeks after surgery.

Conclusion :One of the complications of mitraclip implantation is mitral stenosis as in our patient. As we know mitral stenosis is more serious problem than mitral insufficiency for lvad implantation. And iatrogenic mitral stenosis of this patient was impairing ventricular filling. As in this case clip extraction could ensure effective mitral valve area and ventricular filling for lvad implantation.