Combined Pharmacological and Complex and High-risk Coronary Intervention of Chronic Total Occlusion for Ischemic Mitral Regurgitation

Abstract

Percutaneous coronary intervention for chronic total occlusion is a complex and high-risk intervention (CHIP). Even though persistent ischemia-induced mitral regurgitation is rare, ischemic mitral regurgitation is a frequent complication of an acute coronary crisis. Transcatheter mitral repair has the potential to supplant surgical repair or replacement as the gold-standard treatment for persistent mitral regurgitation. Currently, these interventions are only performed on high-risk surgical candidates, but the indications may eventually be expanded to include low-to-intermediate risk patients as well, in a manner like transcatheter aortic valve replacement. In patients with ischemic cardiomyopathy who still had considerable viable myocardium, combining current guideline-directed pharmacological treatment with interventional complete revascularization decreased hospitalizations for heart failure. We performed a CHIP intervention on the left circumflex artery, which was chronically totally occluded, to address the severe ischemic mitral regurgitation that had been present for a long time.