key: cord-0976811-skqn09z6
authors: Nagaraja, Vinayak; Ming Wang, Tom Kai; Harb, Serge C.; Kapadia, Samir R.
title: Mitraclip insertion to hasten recovery from severe COVID-19 disease
date: 2020-10-16
journal: CASE (Phila)
DOI: 10.1016/j.case.2020.10.004
sha: adeb4e958d6ad4720c591db77fabf62f98dfcbb3
doc_id: 976811
cord_uid: skqn09z6

• Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome (SARS) coronavirus 2 has affected 188 countries worldwide with a global death toll of over half a million; • Patients with valvular heart disease are also at an increased risk of adverse outcomes from coronavirus disease-2019; • Prognosis of patients with the combination of COVID 19 and severe valvular heart disease is poor; • This is the first reported case of MitraClip insertion in a patient with severe COVID 19 infection. This procedure assisted in the patient’s recovery relieving his cardiac burden and pulmonary edema enabling him to undergo colorectal surgery.

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected 188 countries worldwide with a global death toll of over a million. 1 The severe form of the disease is more commonly seen in the elderly and patients with multiple comorbidities and carries a bad prognosis. 1, 2 Patients with valvular heart disease are also at an increased risk of adverse outcomes from COVID-19. 3 MitraClip (Abbott Vascular, Santa Clara, California) has been approved for functional as well as degenerative mitral regurgitation in the USA. [4] [5] [6] [7] [8] We describe a case of 67 year old gentleman with severe COVID-19 infection with multiple complications who underwent MitraClip implantation (Abbott Vascular, Santa Clara, California) to treat with refractory pulmonary edema to hasten recovery from this lethal disease.

A 67-year-old gentleman with asymptomatic Barlow's syndrome developed COVID-19 infection.

Subsequently his prolonged hospital stay (over 2 months) was complicated by respiratory failure needing tracheostomy, acute renal failure needing hemodialysis, large stage IV decubitus ulcer, and protein energy malnutrition. All these complications were as a result of the COVID-19 infection. The patient had difficulty weaning off the ventilator due to recurrent pulmonary edema and prolonged sessions of renal replacement therapy. His other major issue was a large decubitus ulcer that needed debridement and colorectal surgery to provide a diverting colostomy. Clinical 

The true impact of severe valvular heart disease in patients with COVID-19 has not described in literature so far. 3, 9, 10 Nevertheless, it is clear that patients with severe valvular heart disease often tend to be multimorbid, frail and have a higher mortality rate compared to normal population. 3 With future data and research it shall become clear that the prognosis of patients with the combination of COVID-19 and severe valvular heart disease will be poor. 3 The acute hemodynamic effects of MitraClip intervention have been well documented by the EVEREST trial investigators. 11 MitraClip leads an increase in cardiac output (5.0 ± 2.0 l/min to 5.7 ± 1.9 l/min, p = 0.003), and forward stroke volume (57 ± 17 ml to 65 ± 18 ml, p < 0.001). A decrease in systemic vascular resistance (1,226 ± 481 dyn·s/cm(5) to 1,004 ± 442 dyn·s/cm(5), p < 0.001), left ventricular end-diastolic pressure (11.4 ± 9.0 mm Hg to 8.8 ± 5.8 mm Hg, p = 0.016) and left ventricular end-diastolic volume (172 ± 37 ml to 158 ± 38 ml, p < 0.001) was noted post MitraClip. 11 

Severe covid-19

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infection. This procedure assisted in the patient's recovery relieving his cardiac burden and pulmonary edema enabling him to undergo colorectal surgery.