Bail-out use of the Amplatzer Septal Occluder 
for treatment of acute iatrogenic leaflet perforation during the MitraClip procedure in a patient with functional mitral regurgitation

Kłapyta, Adrian; Pręgowski, Jerzy; Chmielak, Zbigniew; Szymański, Piotr; Witkowski, Adam; Demkow, Marcin

doi:10.5114/aic.2018.78336

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…The Amplatzer vascular plug II has been utilized with limited success and in one case, success was achieved by pulling the device across the transseptal puncture to anchor the device 3 . Double disk atrial septal defect closure devices have offered a more attractive symmetric positioning on the MVL and can be stabilized by a MitraClip 4‐6 . Secondary to hemolysis with residual flow through or alongside Amplatzer devices, the more occlusive Gore (W. L. Gore & Associates, Flagstaff, AZ) Cardioform might offer superior short‐term closure 4,6 .…”

Section: Discussionmentioning

confidence: 99%

“…3 Double disk atrial septal defect closure devices have offered a more attractive symmetric positioning on the MVL and can be stabilized by a MitraClip. [4][5][6] Secondary to hemolysis with residual flow through or alongside Amplatzer devices, the more occlusive Gore (W. L. Gore & Associates, Flagstaff, AZ) Cardioform might offer superior short-term closure. 4,6 While the Gore Cardioform device was a consideration because of rapid closure with a lower risk of hemolysis we felt the VSD occluder device, which is designed for high flow and high pressure closure, would be easier to deliver and recapture if necessary with the delivery system crossing back into the left ventricle if needed.…”

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confidence: 99%

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Codeployment of a percutaneous edge‐to‐edge mitral valve repair device and a ventriculoseptal defect occluder device to address complex mitral regurgitation with leaflet perforation

Addis

Law

Mering

et al. 2020

Cathet Cardio Intervent

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An 80-year-old male with severe, complex mitral regurgitation (MR) after recent transcatheter aortic valve replacement presented in heart failure for percutaneous mitral valve repair and possible tricuspid valve repair. Transesopheageal echocardiography (TEE) demonstrated mixed Carpentier Types 1 and 2 components with annular dilation, two leaflet perforations, and excessive leaflet motion (P2 flail). There were three distinct MR jets appreciated reflecting a central coaptation defect and two posterior mitral valve leaflet perforations emanating from a cystic dilatation. Under TEE guidance transseptal puncture and percutaneous edge-to-edge mitral valve repair was performed with a MitraClip XTR device (Abbott, IL). A 10 mm Amplatzer Muscular VSD Occluder (Abbott, Abbott Park, IL) was deployed to close one of the perforations on the posterior leaflet with a significant reduction in MR severity. Attempts at crossing the remaining defect were unsuccessful and the procedure was concluded. The patient recovered uneventfully and transthoracic echocardiography on postoperative day (POD) 1 and again on POD 34 demonstrated normal systolic dominance on pulmonary venous Doppler interrogation, mild to moderate MR, and a mean transvalvular gradient of 5 mmHg. Both devices appeared firmly attached and stable. This is the first documented use of a VSD occluder device in this clinical scenario. Management of complex MR with an approach combining edge-to-edge repair for a central coaptation defect and leaflet flail with codeployment of a VSD occluder device to address a perforated leaflet is feasible and can achieve durable results.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Codeployment of a percutaneous edge‐to‐edge mitral valve repair device and a ventriculoseptal defect occluder device to address complex mitral regurgitation with leaflet perforation

Addis

Law

Mering

et al. 2020

Cathet Cardio Intervent

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“…The retention discs help to prevent device dislocation or embolisation, neither of which was observed in our patients, with some patients having >2 years of follow-up after deployment. The risk of haemolysis, in comparison to other devices, is relatively lower due to the small calibre of the nitinol mesh 8,[15][16][17] . Finally, the AVP-II is relatively less expensive and has a broad range of sizes.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter therapy for residual mitral regurgitation after MitraClip therapy

Niikura

Bae²,

Gössl³

et al. 2019

EuroIntervention

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Aims:We aimed to examine the effectiveness and the optimal technique for transcatheter therapy for residual mitral regurgitation (MR) after MitraClip therapy with the AMPLATZER Vascular Plug II (AVP-II).Methods and results: Nine patients (mean age, 78±4 years) underwent transcatheter therapy with the AVP-II for residual MR after MitraClip therapy. We examined procedural, in-hospital, and 30-day outcomes. Our technique was successful in all cases, with treatment of different types of residual MR, including paraclip, interclip, and leaflet perforation. MR grade decreased significantly from 4+ to 1+ (p<0.0001), with final residual MR being mild or none in seven patients. Mitral stenosis did not occur with plug placement. The optimal deployment technique for reduction of MR was placement with only one segment on the left atrial side of the mitral valve leaflets (n=8). During clinical follow-up (median 155 days), symptom improvement had occurred in all patients (NYHA class, baseline vs follow-up, 3.2±0.4 vs 2.3±0.8; p=0.01) with mild or no symptoms in six patients. There was no procedural mortality, major adverse event(s), device embolisation, haemolysis or need for cardiac surgery.Conclusions: For patients with residual MR after MitraClip therapy, this technique may be effective and safe, especially when deployed with only one segment on the left atrial side of the mitral leaflets.

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“…The first report of leaflet damage following percutaneous edge-to-edge repair was from the case of a patient who had undergone surgery in the EVEREST (Endovascular Valve Edge-to-Edge Repair Study) trial ( 3 ). Few other case reports of leaflet injuries are present in the medical literature ( 3 , 4 , 5 , 6 , 7 , 8 ). More recently, data from the core laboratory events of the EXPAND (A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices) study revealed that leaflet injuries occurred in a minority of cases: 4 of 1,030 patients (0.04%) (F. Asch et al., EURO PCR online course, personal communication, 2020).…”

Section: A Rare Complication That Transforms a Low-risk Into A High-risk Scenariomentioning

confidence: 99%

Leaflet Injuries After Percutaneous Edge-to-Edge Repair

Maisano

2021

JACC: Case Reports

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Bail-out use of the Amplatzer Septal Occluder for treatment of acute iatrogenic leaflet perforation during the MitraClip procedure in a patient with functional mitral regurgitation

Cited by 4 publications

References 6 publications

Codeployment of a percutaneous edge‐to‐edge mitral valve repair device and a ventriculoseptal defect occluder device to address complex mitral regurgitation with leaflet perforation

Codeployment of a percutaneous edge‐to‐edge mitral valve repair device and a ventriculoseptal defect occluder device to address complex mitral regurgitation with leaflet perforation

Transcatheter therapy for residual mitral regurgitation after MitraClip therapy

Leaflet Injuries After Percutaneous Edge-to-Edge Repair

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