Clinician-to-Clinician Update Clinician-to-Clinician Update

Successful Repair of Severe Mitral Regurgitation in a High-Risk Patient

September 2016

Contributed by Gladwin Das, MD, and Gregory Helmer, MD

Elderly patients with severe mitral regurgitation (MR) who are at high surgical risk due to comorbidities—such as previous cardiac surgery, chronic obstructive pulmonary disease (COPD), hypertension, stroke, or renal disease—are often not considered candidates for mitral valve surgery. Here we describe the case of an elderly woman with severe MR and comorbid COPD who was not a candidate for open-chest surgery but who experienced a successful outcome with percutaneous mitral valve repair using the MitraClip.

Patient

A 72-year-old woman was referred to University of Minnesota Health Heart Care specialists for evaluation of severe MR. Her condition was further complicated by co-morbid COPD, which required management with supplemental oxygen.

MitraClip heart diagram-Heart-Care-Case-Study
— Figure 1. Diagram of a heart showing placement of MitraClip device in the mitral valve. Image used with permission. ©2013 Abbott.

Management and Outcome

After consultation among our multidisciplinary M Health Heart Care team, percutaneous mitral valve repair surgery with the MitraClip device was recommended, to which the patient agreed. The care plan was also discussed with the referring provider.

During surgery, 2 MitraClip devices were placed. The patient recovered without sequelae and was released from the hospital after a 2-night stay. At follow up, the patient’s MR was reduced from severe to mild, and she no longer required supplemental oxygen. She currently is able to ambulate independently and reports an improvement in her quality of life.

Discussion

Percutaneous mitral valve repair can improve outcomes for high-risk patient populations who would otherwise not be candidates for surgical repair. A recent study comparing survival rates of a group of high-risk MR patients treated with MitraClip to that of a group of matched, nonsurgically treated patients found the 30-day mortality rate to be 4.2% for the MitraClip group and 7.2% for the nonsurgical group.1

The 1-year mortality rate was 22.4% for the MitraClip group and 32% for the nonsurgical group. Both differences were statistically significant, and both groups included patients with COPD. This study supports the safety of the MitraClip relative to medical therapy at 30 days and demonstrates a survival benefit at 1 year for patients with severe MR and comorbidities that place them at high surgical risk.

References

  1. Velazquez EJ, et al. The MitraClip and survival in patients with mitral regurgitation at high risk for surgery: A propensity-matched comparison. Am Heart J. 2015;170:1050-1059.e3.
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