Percutaneous mitral valve repair: a bridge to transplant after infarction

Acute post-infarct mitral regurgitation (MR) constitutes a severe hemodynamic complication where surgical urgency often faces a prohibitive operative risk. While percutaneous edge-to-edge repair via the MitraClip system has extensively proven its efficacy in the management of chronic MR, clinical data regarding its use in the acute phase remain fragmentary, limited to small series or isolated cases. This case report, presented by Baranov et al. (2026), describes the strategic application of this technology to treat massive acute post-infarct MR in a critically ill patient. The precise objective of this study is to demonstrate the feasibility of the MitraClip procedure as a surgical bridging solution. The authors explore the hypothesis that immediate percutaneous correction of the regurgitation allows for sufficient hemodynamic stabilization to serve as a "bridge" to orthotopic heart transplantation. This approach aims to offer a therapeutic alternative for patients whose clinical severity contraindicates immediate conventional valvular surgery, while ensuring their survival until access to a graft.

Design and protocol of the case study

This clinical case report details the management of a patient presenting with severe acute mitral regurgitation (MR), a direct complication of myocardial infarction. The methodological objective is to document the use of MitraClip technology as a temporary hemodynamic stabilization strategy.

The clinical protocol described includes the following steps:

• Population: A single patient suffering from symptomatic and severe post-infarction mitral regurgitation.
• Procedure: Percutaneous mitral valve repair using the "edge-to-edge" technique with the MitraClip system.
• Clinical objective: Use of the procedure as a "bridge to transplant" to address a life-threatening emergency.
• Assessment: Analysis of the technical feasibility of percutaneous correction in a context of acute mitral regurgitation and observation of the clinical response before orthotopic heart transplantation.

Unlike studies on chronic mitral regurgitation, this approach focuses on the effectiveness of the MitraClip procedure in an acute emergency setting to stabilize the patient until cardiac transplantation is accessible.

Clinical stabilization and transition strategy

The clinical case describes the application of the percutaneous edge-to-edge repair technique (MitraClip) in a patient suffering from severe acute mitral regurgitation (MR) following a myocardial infarction. The authors report that the procedure achieved sufficient clinical stabilization to serve as a bridge to orthotopic heart transplantation (OHT).

Evaluation criteria	Clinical observation reported
Specific indication	Post-infarction acute mitral regurgitation
Procedure performed	Percutaneous edge-to-edge mitral valve repair (MitraClip)
Therapeutic purpose	Bridge to orthotopic heart transplantation
State of evidence	Data limited to isolated cases or small registries

The qualitative observations from this case report highlight the following points:

• Management of instability: Unlike the established protocols for chronic MR, the use of MitraClip in this acute context allowed for the management of the immediate hemodynamic emergency, avoiding high-risk invasive valve surgery in the early post-infarction phase.
• Pathway optimization: The reduction of mitral regurgitation transformed the immediate prognosis, allowing the patient to reach the transplantation stage under optimized physiological conditions.

The authors note that while the efficacy of MitraClip is extensively documented for symptomatic chronic mitral regurgitation, this case demonstrates the technical and clinical viability of the percutaneous procedure as a rescue strategy to secure the patient pathway until heart transplantation.

Clinical analysis: the MitraClip as a rescue strategy

This clinical case illustrates a critical application of MitraClip technology: the stabilization of massive acute post-infarctus mitral regurgitation (MR). While the device's efficacy is extensively documented for chronic MR, its use in the acute phase remains marginal, documented only by limited registries. Here, the percutaneous "edge-to-edge" procedure allowed for the transformation of a precarious hemodynamic situation into a stable transition phase toward heart transplantation.

The major interest of this approach lies in avoiding high-risk conventional surgery on a recently infarcted and structurally unstable myocardium. By reducing regurgitation percutaneously, the authors demonstrate that it is possible to address the life-threatening emergency while preserving the chances of success for a future transplantation. The concept of "bridge to transplant" takes on its full meaning here for patients whose short-term prognosis is compromised but who are eligible for cardiac replacement.

The limitation of this study lies in its nature: a single case report. Although the results are conclusive for this specific patient, they do not allow for the establishment of a standardized protocol. However, this clinical success suggests that the MitraClip should no longer be viewed solely as a palliative solution for chronic MR, but as a strategic hemodynamic resuscitation tool in the arsenal of transplantation centers.

Clinical case summary

This clinical case demonstrates the effectiveness of the MitraClip system in managing acute post-infarction mitral regurgitation. The procedure allowed for immediate hemodynamic stabilization, serving as an essential clinical bridge until an orthotopic heart transplantation could be performed.

In concrete terms, for the practitioner:

• Consider the percutaneous "edge-to-edge" technique for patients in cardiogenic shock or unstable patients whose immediate surgical risk precludes conventional repair.
• Use this option as a "bridge-to-transplant" strategy to improve the clinical and functional status of the recipient before the transplant.
• Target a rapid reduction in regurgitation to prevent target organ failure related to low flow and pulmonary congestion.

Technical lexicon of the study

MitraClip: Percutaneous valve repair system designed to treat mitral regurgitation by securing the valve leaflets together with a metal clip.

Acute post-infarction mitral regurgitation: Sudden and severe valvular insufficiency occurring after myocardial necrosis, caused by a rupture or dysfunction of the subvalvular apparatus (papillary muscles or chordae tendineae).

"Edge-to-edge" technique: A plasty procedure consisting of joining the central portions of the anterior and posterior mitral leaflets, thereby creating a double orifice to reduce the regurgitation volume.

Bridge to transplant: Clinical management strategy aimed at stabilizing a patient in critical condition or cardiogenic shock to ensure survival until organ transplantation.

Orthotopic heart transplantation: Surgical procedure for replacing a failing heart with a healthy donor heart, implanted in the normal anatomical position after recipient cardiectomy.

Percutaneous mitral valve repair: Minimally invasive procedure performed via a transcatheter approach (usually through the femoral vein and a transseptal puncture) to correct mitral regurgitation without the need for a thoracotomy.

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