Hybrid approach for percutaneous mitral valve repair (MitraClip®) followed by minimally invasive direct coronary artery bypass (MIDCAB) in a patient with a high risk constellation.

BACKGROUND

We present a 76-year-old poly-morbid male patient suffering from severe ischemic mitral valve regurgitation. A hybrid approach was suggested by the heart team to treat his multifaceted cardiac pathologies.

METHODS

At first percutaneous mitral valve repair with the mitraclip device was performed to reduce surgical risk. This was then followed by minimally invasive direct coronary artery bypass (MIDCAB).

RESULTS

At day 20 Post mitraclip intervention the patient suffered gastrointestinal bleeding which needed argon plasma coagulation (APC)-therapy and multiple blood transfusions. Stage II of the hybrid procedure was executed on post-intervention day 34 by minimally invasive direct coronary artery bypass (MIDCAB) to left anterior descending artery (LAD). Seven days later the patient was discharged. Up to two years of follow-up, the patient is in stable condition, without recurrent cardiac symptoms.

CONCLUSION

Hybrid approach of percutaneous mitral valve repair followed by MIDCAB is an effective minimally invasive treatment for severe ischemic mitral valve regurgitation and coronary artery disease.