Successful Transcatheter Mitral Valve Repair in an Elderly Patient with Severe Primary Mitral Regurgitation
Introduction
Transcatheter Mitral Valve Repair (TMVR) has emerged as a viable option for patients with high surgical risk, especially those suffering from severe mitral regurgitation (MR). The traditional surgical repair and replacement of the mitral valve have reported mortality rates of 1.5% and 5.5%, respectively, as per the Society of Thoracic Surgery. These rates increase significantly with advanced age and left ventricular dysfunction. TMVR offers an alternative to mitigate these risks, particularly in elderly or frail patients. This case presents an octogenarian with severe mitral regurgitation who successfully underwent TMVR using the MitraClip device.
Case Presentation
An 80-year-old gentleman with a past medical history of coronary artery disease and previous angioplasty to the left anterior descending artery (LAD) presented with a 15-day history of sudden onset shortness of breath (NYHA Class II-III). On clinical evaluation, he was diagnosed with severe primary mitral regurgitation due to flail A2-P2 leaflets. The patient also had a dilated left atrium and moderately reduced left ventricular function. Due to his advanced age and the high surgical risk, TMVR with the MitraClip device was advised.
Treatment Approach
Due to the high surgical risk, Transcatheter Mitral Valve Repair using the MitraClip device was recommended. The patient was admitted one day prior to the procedure and started on prophylactic intravenous antibiotics. On the day of the procedure, the patient was transferred to the cathlab, where he was intubated for general anesthesia. TMVR was performed with the MitraClip XTW device, successfully holding the A2-P2 leaflets. Post-deployment, the patient had only trivial mitral regurgitation, and the transmitral gradient was 4 mmHg, indicating a successful outcome.
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Outcome
The patient was closely monitored in the Intensive Care Unit (ICU) for two to three days following the procedure. He remained hemodynamically stable throughout the post-procedure period and was discharged in a stable condition. Follow-up visits have shown consistent improvement, and the patient continues to recover well.
Conclusion
TMVR with the MitraClip device provides an effective treatment option for high-risk elderly patients with severe mitral regurgitation. In this case, the procedure led to significant improvement in the patient’s symptoms and a stable outcome. Regular follow-up is essential to monitor long-term recovery and valve function.
About Author –
Dr. G. Ramesh , Sr. Consultant Interventional Cardiologist, Proctor for Complex Coronary Interventions , Yashoda Hospitals - Hyderabad
MMD, DM, FACC, FSCAI, FESC
