Percutaneous edge–to–edge repair of mitral regurgitation in cardiac amyloidosis: do it but not too much

Abstract We report the case of a 68 year old man with history of wild type TTR cardiac amyloidosis, treated with tafamidis since 1 year, symptomatic for advanced cardiac failure, already in optimal medical treatment, CRT–D, oral anticoagulation for permanent atrial fibrillation. The patient was hospitalised in our intensive care unit for refractory NYHA IV cardiac failure, anuria, very low ejection fraction combined with severe mitral regurgitation. He was treated with inotropes and diuretics then levosimendan however he remained in very critical state and we discussed the opportunity to reduce the mitral regurgitation by percutaneous edge to edge repair. In this setting of restrictive physiology literature is not unanimous and preload reduction secondary to mitral regurgitation treatment may sometimes be deleterious. We decided to offer our patient edge to edge repair by targeting a moderate reduction of mitral regurgitation and also considering some challenges linked to this pathology as atrial septal involvement with ovalis fossa relevant thickness. The procedure was successful with a reduction of mitral regurgitation grade from severe to mild–to moderate and this allowed the patient to re equilibrate his hemodynamic balance and he was able to be dismissed with a short term follow up program.