Percutaneous edge-to-edge mitral valve repair for symptomatic high surgical risk patients with significant mitral regurgitation - Short term and one year follow up results from a single center in India

Abstract

This series reports the safety and feasibility of MitraClip (Abbott Vascular) in 7 high surgical risk Indian patients with symptomatic mitral regurgitation (MR). The clip was deployed successfully in all patients, and more than one clip was required in 5. All had reduction in MR to ≤2+. Mean mitral valve gradient was 3.0 ± 0.8 mmHg. At 12 months follow up, all were alive, and the MR grade was 1+ in 6 patients and 2+ in one. Mean MV gradient was 3.4 ± 1.0 mmHg. The modified Kansas City Quality of life (KCQ) analysis revealed significant improvement in their quality of life (p < 0.0001).

Keywords: Edge-to-edge MV repair; High surgical risk; MitraClip; Mitral regurgitation.

FigS1

Primary mitral regurgitation (MR) from flail A3 segment. (A&B) Transesophageal echocardiography mid esophageal LV long axis (A) and commissural views (B) with color Doppler showing flail A3 segment and severe mitral regurgitation. (C) Fluoroscopy showing two clips in position. (D) Mid esophageal LV long axis view with color Doppler showing two small jets of MR after implantation of two clips. (E) 3D enface view of mitral valve showing flail A3 segment (arrow). (F) 3D en face view after deployment of 2 clips showing a large lateral orifice (star).

FigS2

Secondary MR with posterior mitral leaflet (PML) restriction. (A) Transesophageal echocardiography mid esophageal 4 chamber view showing PML restriction. (B) Color Doppler imaging showing severe MR. (C) 3D enface view of mitral valve showing restricted PML and regurgitant orifice. (D) Fluoroscopy showing clip in position. (E) Mid esophageal 4 chamber view with color Doppler showing a small residual jet of MR after implantation of the clip. (F) 3D en- face view after deployment of Mitraclip showing double orifice.

FigS3

Radar AxisPlot analysis of QoL Pre and post Mitral valve clipping. This figure demonstrates two concentric irregular polygons, the smaller polygon within the gray border (Pre QoL) and the larger polygon within the amber border (post QoL). The area in each polygon is the response to 21 of 25 QoL questinnaire. The response to each question is scored from -2 to 5. The larger the area the higher the score. Note that in each individual patient as well as the mean of the collective data, the area of the polygon bordered by amber colour is siignificantly larger than the area of the polygon bordered by gray, indicating significant improvement in the quality of life in each and every patient in the study after mitral valve clipping, p < 0.0001.