Valvular involvement in coronary artery disease is an important prognostic factor for cardiac-related mortality. In the past decade, transcatheter edge-to-edge repair (TEER) using the MitraClip (Abbott Vascular, Menlo Park, CA, USA) has emerged as a less-invasive treatment option for patients with severe mitral regurgitation (MR) and a reduced ejection fraction. A recent major trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation [COAPT trial]) investigating this treatment revealed a significant impact in patients with functional MR, a population in which two-thirds have ischemic etiology. This review highlights the mechanism underlying ischemic MR along with a comparison with the surgical interventions and describes the current usage, clinical implications, and future perspectives of TEER using the MitraClip in this patient population.

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A 71-year-old woman who was resuscitated from cardiac arrest after pericardial drainage was admitted to our hospital. Enhanced computed tomography demonstrated pericardial effusion due to rupture of posterior ventricular myocardium. She underwent emergent surgical repair. A 20-mm tear in the extensively necrotic left ventricular posterior wall and active hemorrhaging were identified. Sutureless repair using three sheets of TachoSil (CSL Behring, Tokyo, Japan) and fibrin glue was performed. To reduce ventricular pressure and avoid re-rupture and formation of ventricular aneurysm, deep sedation was continued in the intensive-care unit for two weeks. At more than five months since the surgery, the patient has returned to her normal daily life and is progressing well.

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