Transaxillary Mitral Valve Repair After Failed Percutaneous Edge-to-Edge Repair

As the execution of percutaneous edge-to-edge repair increases, so does the need for surgical treatment of failed procedures. Mitral valve surgery after failed percutaneous edge-to-edge repair can be complex, and the feasibility of surgical mitral valve repair or replacement depends on the patient’s underlying systemic conditions and the time between the primary percutaneous and the secondary surgical procedures. In some settings, a minimally invasive approach may enable complex valve surgery that promotes both faster recovery and increased patient satisfaction (1). 

This video shares the transaxillary approach to a mitral valve repair in a patient who had undergone a MitraClip implantation for a severe functional mitral valve regurgitation a few days earlier. 

Case Notes 

The patient was a sixty-four-year-old female with a significant functional mitral valve insufficiency and a severe left ventricle disfunction (EF 25%). Because of her frailty and poor left ventricle function, a percutaneous approach through a single MitraClip implantation was deemed most appropriate. An intraprocedural echocardiography showed a good result with a mild residual regurgitation without significant transvalvular gradients.  

However, a few days later, an echocardiogram revealed a residual severe mitral valve regurgitation because of MitraClip dislocation and posterior leaflet 2 (P2) perforation. Through a direct access transaxillary approach, the valve was repaired by removing the clip, reconstructing the damaged posterior leaflet, and implanting a downsized semirigid complete ring. The procedure was successful, and the patient was uneventfully discharged seven days postoperatively. 

Reference

1. Di Eusanio M, Berretta P, Alfonsi J, et al. Ultrafast-Track Mini Mitral Valve Repair: Direct Access Transaxillary Approach. October 2019. doi:10.25373/ctsnet.9899270

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