key: cord-1020015-ogbyv7gh
authors: Chen, Chunguang; Okoh, Alexis K.; Stump, Katherine; Smith, Meghan; Pannebianco, Cassey; Sethi, Ankur; Lee, Leonard Y.; Russo, Mark J.
title: Expedited Mitra clip: Rapid evaluation, treatment, and discharge in the COVID-19 era
date: 2020-11-16
journal: Cardiovasc Revasc Med
DOI: 10.1016/j.carrev.2020.11.012
sha: cb623eb1a0970555e8a511fa27aaffeba3ff9c77
doc_id: 1020015
cord_uid: ogbyv7gh

Undertreatment of patients with severe mitral regurgitation (MR) has been exaggerated during the coronavirus disease of 2019 (COVID-19) pandemic. Expedited workup and shortened post-procedural hospital stay after percutaneous mitral valve repair (PMVR) would be incredibly helpful to relieve the constrain in the era of the COVID-19 pandemic and immediately afterward. We report a patient who underwent PMVR with a simplified pre-operative workup, a shortened hospital stay, and expedited discharge.

mmHg, and trivial pericardial effusion. The patient was transferred to the catheterization laboratory recovery area. On admission, a baseline EKG was performed. A repeat EKG was done after 4-hours post-procedure, and no changes were noted. Bedside TTE confirmed clip placement with no evidence of pericardial effusion; The patient was subsequently ambulated. After confirming each of these milestones, he was set up for same day discharge (SDD). Follow up: After SDD, the patient was followed with a home continuous ECG system (Zio AT ® Patch iRhythm Technologies, Inc) for 7-days. This system alerts the patient and provider to conduction changes in real-time. This is a standard follow-up for all patients discharged within five days of catheter-based or open surgical valve replacement at our center. Besides, the patient had a virtual visit follow-up on post-procedure days 1 and 2. After a follow-up duration of 10 days, the patient continues to do well without the need for rehospitalization. Discussion: As a result of the COVID-19 pandemic, our structural heart program has attempted to adopt a minimal inpatient footprint strategy. This protocol includes limiting the use of resources, limiting the number of areas that our patients visit, and limiting their time in the hospital. We have adopted this approach for multiple reasons. First, even after the pandemic's effects lessened, many areas of our hospital where structural heart patients are typically managed had been repurposed to the management of COVID patients and were at high capacity or unavailable. Also, the population of patients undergoing structural heart procedures is overwhelmingly advanced in age with a high prevalence of hypertension and diabetes, and therefore they are at too high risk for the adverse outcome if infected with COVID19. Moreover, to protect patients, families, and the hospital staff, visitors, were not allowed in the hospital. Thus all hospitalized would be separated from their loved ones during their time in the hospital. Streamlined workup. Our program has required all patients to undergo a screening TEE before transcatheter mitral valve intervention in the recent past. However, given expanded indications, advances in the technology, and the new realities of the COVID era, we now plan to schedule patients who had a diagnostic TTE demonstrating severe mitral regurgitation and preliminary classification of mitral anatomy to exclude unfavorable anatomy for MitraClip for confirmatory TEE with possible clip for a one-stop procedure. [ Figure 2 ] Recognizing that a small proportion of patients will be rejected on the table immediately before the procedure. However, this strategy is no different from managing ischemic cardiac disease when a patient who has suspected coronary disease after a stress test is scheduled for diagnostic cardiac catheterization and possible percutaneous coronary intervention. During the pandemic's peak, a few patients referred to our center with severe MR were successfully managed with this protocol. Post-procedure, there were no complications or reported adverse events. The intent of the present work herein is to demonstrate the safety and feasibility of SDD post MitraClip procedures. This report offers an alternative for treatment in patients who are in the most need of intervention during the ongoing pandemic.

To further expedite treatment, the patient was evaluated via a virtual telemedicine consultation. Besides, the patient was followed remotely with virtual telehealth follow-up visits and continuous remote cardiac monitoring. 

Transcatheter Mitral-Valve Repair in Patients With Heart Failure

This case illustrates that PMVR with MitraClip with limited inpatient care, including same-day discharge, is safe and feasible in a group of well-selected patients. Disclosures: Mark J Russo, MD, MS serve as a speaker for Edward Life Sciences and Abbott Laboratories. All other authors have no disclosures to declare.