Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;98(4):E617-E625.
doi: 10.1002/ccd.29703. Epub 2021 Apr 15.

Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review

Eduardo Martinez-Gomez  1 , Angela McInerney  1 , Gabriela Tirado-Conte  1 , Jose Alberto de Agustin  1 , Pilar Jimenez-Quevedo  1 , Andrés Escudero  1 , Eduardo Pozo Osinalde  1 , Ana Viana-Tejedor  1 , Josebe Goirigolzarri  1 , Luis Marroquin  1 , David Vivas  1 , Carlos Ferrera  1 , Francisco Noriega  1 , Maria Alejandra Restrepo-Cordoba  1 , Nieves Gonzalo  1 , Javier Escaned  1 , Antonio Fernández-Ortiz  1 , Ignacio Amat-Santos  2 , Rodrigo Estevez-Loureiro  3 , Carlos Macaya  1 , Luis Nombela-Franco  1
Affiliations

Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review

Eduardo Martinez-Gomez et al. Catheter Cardiovasc Interv. 2021 Oct.

Abstract

Background: Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip.

Methods: We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included.

Results: Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1-4), with an in-hospital mortality and non-fatal complication rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an overall mortality rate of 39.1% at 12-month follow-up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention.

Conclusions: Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.

Keywords: MitraClip; acute mitral regurgitation; cardiogenic shock; mitral edge-to-edge repair; mortality.

PubMed Disclaimer

References

REFERENCES

    1. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol. 2015;66:2844-2854.
    1. Baumgartner H, Falk V, Bax J, et al. 2017 ESC/EACTS guidelines or the management of valvular heart disease. Eur Heart J. 2017;38:2739-2791.
    1. Nishimura R, Otto C, Bonow R, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2017;70:252-289.
    1. Stone GW, Lindenfeld J, Abraham W, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379:2307-2318.
    1. Monteagudo JM, Galderisi M, Buonauro A, et al. Overview of mitral regurgitation in Europe: results from the European registry of mitral regurgitation (EuMiClip). Eur Heart J Cardiovasc Imaging. 2018;9:503-507.

Publication types

LinkOut - more resources