87 year old male with known history of mitral regurgitation, hypertension, hyperlipidemia, CAD s/p DES PCI to RCA (2010 and 2015), ischemic cardiomyopathy, carotid artery stenosis, and frailty presents with worsening dyspnea on exertion NYHA Class III for 6 months. A transthoracic echocardiogram showed LVEF 30%, moderately dilated LV (LVIDs 4.8 cm, LVIDd 6.3 cm) with severe global hypokinesis, mildly dilated LA, and severe mitral regurgitation. A subsequent transesophageal echocardiogram (TEE) revealed a moderately dilated LV with annular dilation, partial prolapse of the posterior mitral valve leaflet with severe centrally-directed mitral regurgitation involving the A2/P2 segment and no mitral stenosis. The STS mortality risk for surgical MVR is 4.1% and the logistic Euroscore mortality risk is 13.1%. The patient underwent a Heart Team evaluation and was found to be prohibitive risk for surgical MVR due to comorbidities, advanced age and frailty. Patient is now planned for edge-to-edge mitral valve repair with MitraClip via a transfemoral venous access and transseptal puncture.
