Successful MitraClip Procedure Following Surgical Inferior Vena Cava Filter Removal

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Objective: Mitral valve transcatheter edge-to-edge repair (TEER) is an effective therapeutic alternative to mitral valve surgery for high-risk surgical patients with mitral regurgitation (MR). The TEER route necessitates the use of the femoral vein approach. We present a case report of a patient with atrial functional MR (AFMR) and an indwelled inferior vena cava filter (IVCF) who underwent TEER using the MitraClip system (Abbott Vascular, Santa Clara, CA, USA).

Case Presentation: A 78-year-old male with an IVCF experienced frequent hospitalization for heart failure (HF) due to severe AFMR despite receiving maximally tolerated doses of guideline-directed medical therapy. Treatment for AFMR was necessary to prevent HF-related hospitalization. Considering the patient’s high surgical risk and frailty, a minimally invasive approach was favored. However, the presence of the indwelled IVCF obstructed the use of the femoral vein for the MitraClip approach. Computed tomography revealed that all IVCF struts had penetrated the inferior vena cava (IVC) wall. Our heart team determined that endovascular venoplasty or stenting to establish the MitraClip approach route posed a high risk of IVC rupture. Consequently, we initially performed surgical IVCF removal, followed by TEER using the MitraClip system via conventional femoral vein access after one month. Following the intervention therapies, the patient has remained free from HF-related rehospitalization for 2 years.

Conclusion: Surgical IVCF removal emerges as a viable treatment option for establishing the MitraClip system access route.