Left Ventricular Assist Device Implantation after MitraClip Procedure

Objective: Functional mitral valve regurgitation is a frequent consequence of left ventricular dysfunction in heart failure patients and associated with poor prognosis. It is hypothesized that in this patient group the mitral valve repair, respective replacement, improves hemodynamics and clinical symptoms. As operative interventions with the help of heart-lung-machine are high risk procedures, in these cases, the transcatheter mitral repair with MitraClip (Abbott Vascular, IL, USA) has become frequently used. Most of these cases experience a progress in left ventricular dysfunction, which finally leads to in an implantation of a left ventricular assist device. In this report, we describe a series of six cases in which patients with end stage heart failure and consecutive functional mitral valve regurgitation were supported with a left ventricular assist device after MitraClip implantation. We aimed to investigate, whether the MitraClip implantation leads to an improvement of the hemodynamic prior LVAD-implantation.

Methods: We retrospectively analyzed the data of 6 patients with severe heart failure, who underwent LVAD implantation after the MitraClip procedure. The parameters examined were CI, LVEF, LVEDD and the PCWP.

Results: This case series includes 6 patients (5 male, 1 female). The mean age at MitraClip procedure was 64.6 years. The mean age at time of LVAD implantation was 65.5 years. All patients had functional mitral regurgitation (MR). Severity of MR was reduced successfully in all treated patients. All patients were discharged with MR I-II and NYHA functional class III or IV after MitraClip-procedure. The mean CI was 2.93 before MitraClip-procedure and 2.36 before LVAD-Implantation. Mean LVEDD was 71 mm before MitraClip, mean LVEDD was 70.6 mm before LVAD, and 63.2mm after LVAD implantation respectively. The mean PCWP was 21.5 mm Hg before MitraClip and 19.8 mm Hg before LVAD implantation respectively. The mean LVEF was 19.2% before MitraClip, the mean LVEF was 17.6% before LVAD and 15% after LVAD implantation. Two of the LVAD implanted patients died due to postoperative complications. There were no complications after MitraClip procedure.

Conclusion: Our presented patient cohort presented little hemodynamic improvement after the MitraClip procedure. There was no clinical benefit for the patients after MitraClip procedure, progressing left ventricular dysfunction could not be prevented and resulted in subsequent LVAD implantation.