Impella-Clip: a secure and effective strategy in cardiogenic shock due to acute severe mitral regurgitation

CASE PRESENTATION This is the case of a 61-year-old man with cardiovascular risk factors who presents with a 3-day history of intermittent oppressive pain in the middle of his chest. The electrocardiogram confirmed the presence of an inferior-posterior wall ST-segment elevation. The emergency coronary angiography revealed the acute occlusion of a dominant left circumflex artery (videos 1 and 2 of the supplementary data) that was revascularized with 2 drug-eluting stents in the proximal left circumflex artery (bifurcation with the first obtuse marginal artery) using the TAP technique (T and small protrusion) (figure 1 and video 3 of the supplementary data). No other significant epicardial lesions were found. During the procedure the patient became desaturated, developed progressive hypotension, and eventually required invasive mechanical ventilation and intra-aortic balloon pump implantation. The echocardiogram confirmed the presence of significant mitral regurgitation (MR) with a slightly depressed left ventricular ejection fraction (LVEF) and inferior-lateral and apical akinesis with preserved right ventricular function. The transesophageal echocardiography confirmed the diagnosis of acute mitral regurgitation of ischemic etiology with a predominant jet at medial level, and no organ damage to the valve or the subvalvular apparatus (figure 2 and video 4 of the supplementary data). Within the next few...