Background 

The prevalence of left ventricular (LV) thrombus formation following percutaneous mitral valve repair with the MitraClip system is unclear but may occur more frequently in patients with reduced left ventricular ejection fraction. LV thrombus may cause disabling stroke or other thromboembolic events in this elderly and multimorbid patient cohort that severely affect survival and quality of life. 

Objective

Analysis of the incidence of and risk factors for left ventricular thrombus formation in patients treated with the MitraClip system due to severe mitral valve regurgitation. 

Methods 

All discharge and follow-up transthoracic echocardiographic (TTE) examinations up to 6 months of 453 consecutive patients treated with the MitraClip system between 11/2012 and 10/2017 were screened for the presence of LV-thrombus. 

Results

No LV thrombi were found in patients with LV-EF>30% (n=358). In the cohort of patients with severely depressed left ventricular function (LVEF ≤ 30%; n=69), 7.5 % of patients (n=5) were diagnosed with LV thrombus after MitraClip implantation in follow-up echocardiographies. Two of these patients were under active DOAC (Rivaroxaban and Apixaban) therapy.

Conclusion

LV thrombus formation following percutaneous mitral valve repair is a rare complication and was associated with severely depressed left ventricular function in our cohort. As two patients developed LV thrombus despite of DOAC therapy, anticoagulation with a Vitamin K antagonist should be strongly considered.