Expedited MitraClip: Rapid Evaluation, Treatment, and Discharge in the COVID-19 Era

Abstract

Undertreatment of patients with severe mitral regurgitation (MR) has been exaggerated during the coronavirus disease of 2019 (COVID-19) pandemic. Expedited workup and shortened post-procedural hospital stay after percutaneous mitral valve repair (PMVR) would be incredibly helpful to relieve the constrain in the era of the COVID-19 pandemic and immediately afterward. We report a patient who underwent PMVR with a simplified pre-operative workup, a shortened hospital stay, and expedited discharge.

Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond

“…In a case report by Chen et al [ 25 ], they describe an expedited Mitra-clip procedure for an 86-year-old patient with severe MR who was discharged on the same day during the COVID-19 pandemic. His STS risk score was 4.2%, with an EF of 40%, and NYHA III heart failure symptoms.…”

“…Following the procedure, the patient was observed for four hours, a TTE showed no pericardial effusion, and confirmed the placement of the Mitraclips. The patient was sent home with a 7 d continuous rhythm-monitoring device without any documented arrhythmia and was seen on days 1 and 2 after the procedure via telephone-health calls[ 25 ]. These prior studies indicate that SDD is reasonable and possible for selected patients undergoing the Mitra-clip procedure without procedural complications and with adequate follow-up.…”

Never Let a Crisis Go to Waste: What Have We Learned About Clinical Pathways for Transcatheter Structural Heart Interventions?

“… 13 We envisioned a not-too-distant future of ambulatory surgical centers for transcatheter structural heart intervention, provided that emergency care protocols and U.S. reimbursement concerns could be thoughtfully mitigated. These strategies may be more favorable for transcatheter mitral edge to edge repair, 18 , 19 left atrial appendage occlusion, and transcatheter closure of patent foramen ovale or interatrial septal defects, which have decreased risk of conduction disorder/permanent pacemaker or vascular complications as compared to TAVR. There will be more, not less, reevaluation of clinical pathways; the COVID-19 pandemic has forever changed health care and the health care workforce.…”