JACC: CARDIOVASCULAR INTERVENTIONS

VOL. 7, NO. 7, 2014

ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 1936-8798/$36.00

PUBLISHED BY ELSEVIER INC.

http://dx.doi.org/10.1016/j.jcin.2013.11.027

IMAGES IN INTERVENTION

Catheter-Based Edge-to-Edge Mitral Valve Repair After Percutaneous Mitral Valve Annuloplasty Failure Carmelo Grasso, MD,* Guilherme F. Attizzani, MD,* Yohei Ohno, MD,* Fabio Dipasqua, MD,* Sarah Mangiafico, MD,* Margherita Ministeri, MD,* Anna Caggegi, MD,* Stefano Cannata, MD,* Salvatore Scandura, MD,* Corrado Tamburino, MD, PHD*y Catania, Italy

A 68-year-old high-risk (STS mortality risk score 15.7%) woman presented with congestive heart failure (New York Heart Association functional class III) and severe mitral regurgitation (MR) (vena contracta 7 mm) 1.5 years after percutaneous implantation, in a different hospital, of the Carillon device (CD) (Cardiac Dimensions, Kirkland, Washington) as a result of severe functional MR. After discussion with the local heart

team, uneventful implantation of 2 MitraClips (Abbott Vascular, Abbott Park, Illinois) was performed. Notably, there was marked reduction in the MR, and no concerns regarding increased mitral gradient were demonstrated (Fig. 1). Coronary sinus–based mitral annuloplasty with the CD has been shown to be feasible and lead to quality-of-life and exercise tolerance improvement 6 months after implantation in patients with

Figure 1. MR After CD Failure Treated With the Implantation of 2 MitraClips Angiography (A) demonstrates that the Carillon device (CD) is in place (white arrow), whereas the echocardiographic image (B) depicts the CD in the coronary sinus (white arrow). Severe mitral regurgitation (MR) is demonstrated in the 4-chamber view (C); the first MitraClip (red arrow) and the CD (white arrow) are shown in the oblique 3-dimensional (3D) view (D). Final angiography (E) demonstrates the CD (white arrow) and the 2 implanted MitraClips (red arrows) that led to marked reduction of MR (F) with minimal transmitral gradient (G). (H) A 3D atrial oblique view shows the double orifice (white asterisks) and the CD in the coronary sinus (white arrow).

From the *Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; and the yExcellence Through Newest Advances (ETNA) Foundation, Catania, Italy. Dr. Ohno is supported by a grant from the Japan Heart Foundation and Bayer Yakuhin Research Grant

Abroad. Dr. Attizzani has received consulting fees from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received November 6, 2013; accepted November 21, 2013.

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Grasso et al. MitraClip After Percutaneous Annuloplasty Failure

functional MR (1). In the present case, however, it failed to obtain adequate reduction of functional MR in a patient with prohibitive surgical risk. The decision of our group for the percutaneous edge-to-edge mitral valve repair, therefore, was based on the patient’s high surgical risk and on clinical symptoms improvement coupled with left ventricular reverse remodeling demonstrated in the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk study (2). In addition, data from the EVEREST trial suggest that the benefit of MitraClip implantation is more pronounced in patients with functional MR when compared with degenerative MR (3); nevertheless, this subgroup analysis warrants further investigation in a randomized fashion. To our knowledge, this is the first report of MitraClip implantation after CD failure for MR. This successful intervention, therefore, opens a new avenue in the investigation of MitraClip therapy, as we recently demonstrated in patients with previous surgical annuloplasty failure (4).

JACC: CARDIOVASCULAR INTERVENTIONS, VOL. 7, NO. 7, 2014 JULY 2014:e85–6

Reprint requests and correspondence: Dr. Carmelo Grasso, Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 1, 95100, Catania, Italy. E-mail: [email protected] REFERENCES

1. Schofer J, Siminiak T, Haude M, et al. Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARILLON Mitral Annuloplasty Device European Union Study. Circulation 2009;120:326–33. 2. Whitlow PL, Feldman T, Pedersen WR, et al. Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study. J Am Coll Cardiol 2012;59:130–9. 3. Feldman T, Foster E, Glower DD, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 2011;364:1395–406. 4. Grasso C, Ohno Y, Attizzani GF, et al. Percutaneous mitral valve repair with the MitraClip system for severe mitral regurgitation in patients with surgical mitral valve repair failure. J Am Coll Cardiol 2014;63:836–8.

Key Words: carillon - MitraClip - mitral regurgitation percutaneous mitral valve annuloplasty.

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Catheter-based edge-to-edge mitral valve repair after percutaneous mitral valve annuloplasty failure.

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