Transcatheter Edge-to-Edge Repair in Patients with Left Ventricular Assist Device Support

Abstract

<h3>Introduction</h3> Reverse remodeling and myocardial recovery may occur during left ventricular assist device (LVAD) support. Persistent or recurrent mitral regurgitation (MR) might prevent successful LVAD weaning and should therefore be ruled out before LVAD explantation can be considered. We present a case series of transcatheter edge-to-edge repair (TEER) performed in 5 patients on LVAD support at our institution between January 1^st, 2016 and December 1^st, 2020. <h3>Case Report</h3> At the time of the procedure, patient age ranged from 30 to 71 years and patients were on LVAD support because of dilated cardiomyopathy or fulminant myocarditis for 1 to 4 years. All patients had shown signs of myocardial recovery and pump-stop echocardiography unmasked severe MR (Carpentier type II). The procedures were performed to assess the potential of LVAD weaning with a competent mitral valve. TEER was performed via femoral/transseptal access in general anesthesia and under transesophageal echocardiographic and fluoroscopic guidance. A reduction of MR from severe to mild was achieved by placing 1 or 2 clips. No postinterventional mitral stenosis was seen. All patients were transferred from the recovery room directly to normal ward and discharged after oral anticoagulation was restarted and INR was within the therapeutic range. In one patient, the hospital stay was prolonged due to management of a local driveline infection, which was unrelated to the procedure. In the further course, no complications according to Mitral Valve Academic Research Consortium criteria were observed. Subsequently, one patient met the LVAD weaning criteria and underwent successful LVAD explantation. <h3>Summary</h3> Transcatheter edge-to-edge repair post LVAD implantation is a safe alternative to concomitant MV surgery during LVAD implantation and may help to stratify patients with myocardial recovery for device explantation.