Impella-Clip: a secure and effective strategy in cardiogenic shock due to acute severe mitral regurgitation. How would I approach it?

Abstract

HOW WOULD I APPROACH IT? In their case presentation, authors described an interesting case of acute severe mitral regurgitation of functional etiology due to inferior wall myocardial infarction progressing into cardiogenic shock. Acute and subacute mitral regurgitation due to myocardial infarction is a clinical condition of grim prognosis that is relatively common in our routine clinical practice.1 These patients’ sign of presentation can be rapidly progressive heart failure hours or days after the ischemic event with poor response to medical therapy. No wonder then that, on many occasions,2,3 in the evolved infarction without reperfusion or delayed reperfusion setting, severe rapidly progressive courses towards cardiogenic shock can occur. The fundamental anatomical mechanism through which mitral regurgitation occurs can be posterior leaflet restriction often in its more medial or medial-central scallops (P3 or P2-P3) due to specific regional dysfunction of myocardial contractility due to infarction.1 As in the case presented here, these are often inferior or inferior-posterior wall myocardial infarctions due to the occlusions of very-well developed left circumflex arteries or very dominant right coronary arteries. These are high-surgical risk patients following their poor clinical and hemodynamic situation. Although, traditionally, the only possible procedure for these patients was mitral valve repair or replacement surgery, surgical results are...