Percutaneous mitral valve repair with the MitraClip® system under deep sedation and local anaesthesia

Abstract

For appropriately selected patients with severe mitral regurgitation, percutaneous mitral valve repair with the MitraClip® system is a promising alternative to open chest surgery. The procedure requires transoesophageal echocardiographic guidance and is performed under general anaesthesia. However, many patients undergoing percutaneous repair are at high risk for complications related to anaesthesia. We report our initial experience in the use of the MitraClip® system under deep sedation and local anaesthesia in five consecutive cases. Five patients (two male, three female), median age 79 years (range 71 to 88 years), four with moderate to severe mitral regurgitation suitable for percutaneous repair, underwent the MitraClip® procedure under local anaesthesia and deep sedation. All procedures were completed without general anaesthesia. All patients received 2 mg of midazolam, and propofol was administered according to response during the course of the procedure with 20-60 mg required per case. The median duration of the procedures was 88 (74 to 193) minutes, and the median duration of procedural TEE was 64 (59 to 193) minutes. Four of five procedures were carried out successfully. Three patients required one clip and one patient required two clips. In one patient, the clip was eventually withdrawn and not implanted because it did not lead to an adequate reduction of mitral insufficiency. The implantation of a MitraClip® is feasible under local anaesthesia and sedation. In patients at high risk for complications related to general anaesthesia, percutaneous mitral valve repair under local anaesthesia may be a viable alternative.