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Anesthesia management for MitraClip device implantation

Annals of Cardiac Anaesthesia. 2014;17(1):17-22 DOI 10.4103/0971-9784.124126

 

Journal Homepage

Journal Title: Annals of Cardiac Anaesthesia

ISSN: 0971-9784 (Print); 0974-5181 (Online)

Publisher: Wolters Kluwer Medknow Publications

Society/Institution: Indian Association of Cardiovascular Thoracic Anaesthesiologists

LCC Subject Category: Medicine: Surgery: Anesthesiology | Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system

Country of publisher: India

Language of fulltext: English

Full-text formats available: PDF, HTML, ePUB

 

AUTHORS


Harikrishnan Kothandan

Ho Vui Kian

Yeo Khung Keong

Hwang Nian Chih

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 26 weeks

 

Abstract | Full Text

Aims and Objectives: Percutaneous MitraClip implantation has been demonstrated as an alternative procedure in high-risk patients with symptomatic severe mitral regurgitation (MR) who are not suitable (or) denied mitral valve repair/replacement due to excessive co morbidity. The MitraClip implantation was performed under general anesthesia and with 3-dimensional transesophageal echocardiography (TEE) and fluoroscopic guidance. Materials and Methods: Peri-operative patient data were extracted from the electronic and paper medical records of 21 patients who underwent MitraClip implantations. Results: Four MitraClip implantation were performed in the catheterization laboratory; remaining 17 were performed in the hybrid operating theatre. In 2 patients, procedure was aborted, in one due to migration of the Chiari network into the left atrium and in second one, the leaflets and chords of the mitral valve torn during clipping resulting in consideration for open surgery. In the remaining 19 patients, MitraClip was implanted and the patients showed acute reduction of severe MR to mild-moderate MR. All the patients had invasive blood pressure monitoring and the initial six patients had central venous catheterization prior to the procedure. Intravenous heparin was administered after the guiding catheter was introduced through the inter-atrial septum and activated clotting time was maintained beyond 250 s throughout the procedure. Protamine was administered at the end of the procedure. All the patients were monitored in the intensive care unit after the procedure. Conclusions: Percutaneous MitraClip implantation is a feasible alternative in high-risk patients with symptomatic severe MR. Anesthesia management requirements are similar to open surgical mitral valve repair or replacement. TEE plays a vital role during the MitraClip implantation.