What To Do When A Mitraclip Fails?
Author: Evandro C. R. Lopes, Cláudio Albernaz César, Priscila A. H. Maya, Gustavo Barone Perez.

Cardio Assist, CAMPO GRANDE - MS, Brazil.

Abstract:
BACKGROUND: MitraClip may be indicated for severe regurgitation but aren't a good candidate for mitral valve repair and replacement surgery. After failure of mitraclip therapy, surgical correction is necessary. By opting for a minimally invasive approach, we reduce trauma and the risk of complications. We report 1 case of severe mitral stenosis after implantation of two mitraclips corrected with valve prosthesis implantation. METHODS: After general anesthesia with a single lumen orotracheal tube and myofascial block, the patient was positioned in the left lateral decubitus position at 30 degrees. Right axillary thoracotomy was performed and, using extracorporeal circulation via the femoral route, the aorta was clamped and modified Del Nido cardioplegic solution was administered. Through videothoracoscopy, the Sondergaard groove was excised. The mitral valve was completely closed with the mitraclips. Mitral valve was removed, stitches were passed and bioprosthesis #31 was implanted. Left atrium was sutured in 2 layers. RESULTS: The patient was extubated in the operating room and taken to the ICU. The following morning drain and catheters were removed.The patient remained with a temporary pacemaker, stimulating intermittently. On the third postoperative day, the patient underwent implantation of a bicameral pacemaker. She remained in the hospital until the 10th postoperative day due to the need for cardiopulmonary rehabilitation. CONCLUSIONS: Even critically ill patients at high surgical risk can benefit from a minimally invasive approach as long as a qualified multidisciplinary team is available.