MitraClip implantation under sedation

Abstract

The percutaneous MitraClip system is a catheter-based device designed to perform edge-to-edge mitral valve (MV) leaflet repair at the site of regurgitation. MitraClip implantation is an alternative procedure in patients at high surgical risk with symptomatic severe mitral regurgitation (MR) who are not candidates for MV repair/replacement due to their degree of comorbidity and associated high mortality risk. The procedure is guided by 3-dimensional (3D) transesophageal echocardiography (TEE) and fluoroscopy. A clip is positioned between the anterior and posterior leaflet to reduce valve regurgitation. Quantitatively, the reduction in MR is less than with surgical repair, but it significantly improves patients' quality of life and functional capacity. Advantages are avoidance of sternotomy and cardiopulmonary bypass, beating-heart repair of the MV and reduction in post-operative duration of mechanical ventilation, intensive care unit (ICU) stay and need for blood transfusion. General anesthesia (GA) with orotracheal intubation is the most common approach in the literature because of the TEE probe and the need for the patient to be immobilized during the procedure. Since May 2014, of the 39 patients who have had MitraClip implantation in our hospital, only two were under deep sedation. We describe here the case of a MitraClip implantation performed under deep sedation with ketamine and propofol infusion in a patient unsuitable for surgical repair because of her comorbidities.

Keywords: Anestesia geral; Ecocardiografia transesofágica; General anesthesia; Implantação percutânea de MitraClip; Insuficiência mitral; Ketamina; Ketamine; Mitral regurgitation; Percutaneous MitraClip implantation; Propofol; Sedation; Sedação; Transesophageal echocardiography.