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. 2015 Jul;4(4):335-40.
doi: 10.3978/j.issn.2225-319X.2015.02.02.

Current state of transcatheter mitral valve repair with the MitraClip

Emily A Downs  1 , D Scott Lim  1 , Mike Saji  1 , Gorav Ailawadi  1
Affiliations

Current state of transcatheter mitral valve repair with the MitraClip

Emily A Downs et al. Ann Cardiothorac Surg. 2015 Jul.

Abstract

Background: Many patients affected with mitral valve regurgitation suffer from multiple comorbidities. The MitraClip device provides a safe means of transcatheter valve repair in patients with suitable mitral valve anatomy who are at prohibitive risk for surgery. We describe our early procedural outcomes and present a summary of the current state of MitraClip technology in the United States.

Methods: We performed a retrospective chart review of initial high-risk or inoperable patients who underwent MitraClip placement at our institution after completion of the EVEREST II study. We examined the primary outcome of 30-day mortality, and secondary outcomes included extent of reduction of mitral regurgitation (MR), New York Heart Association (NYHA) functional class improvement, length of stay, and major complications.

Results: A total of 115 high-risk patients (mean Society of Thoracic Surgeons predicted risk of mortality 9.4%±6.1%) underwent the MitraClip procedure at our institution between March 2009 and April 2014. Co-morbidities including coronary artery disease (67.8%), pulmonary disease (39.1%) and previous cardiac surgery (44.3%) were common. The device was placed successfully in all patients with a 30-day mortality of 2.6%. All patients demonstrated 3+ or 4+ MR on preoperative imaging, and 80.7% of patients had trace or 1+ MR at hospital discharge. NYHA class improved substantially, with 79% of patients exhibiting class III or IV symptoms pre-procedure and 81% reporting class I or II symptoms at one month follow-up.

Conclusions: The MitraClip procedure provides a safe alternative to surgical or medical management for high-risk patients with MR and suitable valve anatomy. A comprehensive heart team approach is essential, with surgeons providing critical assessment of patient suitability for surgery versus percutaneous therapy as well as performance of the valve procedure.

Keywords: Mitral regurgitation (MR); cardiac catheterization/intervention; percutaneous.

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Figures

Figure 1
Figure 1
Intraprocedural TEE images. (A) Posterior leaflet flail; (B) with color Doppler; (C) post-placement of 2 MitraClips; (D) with color Doppler. TEE, transesophageal echocardiography.
See this image and copyright information in PMC

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