scholarly journals Conceiving MitraClip as a tool: percutaneous edge-to-edge repair in complex mitral valve anatomies

2020 ◽  
Vol 21 (10) ◽  
pp. 1059-1067
Author(s):  
Mara Gavazzoni ◽  
Maurizio Taramasso ◽  
Michel Zuber ◽  
Giulio Russo ◽  
Alberto Pozzoli ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Clinical Studies ◽  
Mitral Insufficiency ◽  
Heart Team ◽  
Severe Mitral Regurgitation ◽  
Review Of The Literature ◽  
Surgical Risk ◽  
High Surgical Risk

Abstract Improvements in procedural technique and intra-procedural imaging have progressively expanded the indications of percutaneous edge-to-edge technique. To date in higher volume centres and by experienced operators MitraClip is used for the treatment of complex anatomies and challenging cases in high risk-inoperable patients. This progressive step is superimposable to what observed in surgery for edge-to-edge surgery (Alfieri’s technique). Moreover, the results of clinical studies on the treatment of patients with high surgical risk and functional mitral insufficiency have confirmed that the main goal to be achieved for improving clinical outcomes of patients with severe mitral regurgitation (MR) is the reduction of MR itself. The MitraClip should therefore be considered as a tool to achieve this goal in addition to medical therapy. Nowadays, evaluation of patient’s candidacy to MitraClip procedure, discussed in local Heart Team, must take into account not only the clinical features of patients but even the experience of the operators and the volume of the centre, which are mostly related to the probability to achieve good procedural results. This ‘relative feasibility’ of challenges cases by experienced operators should always been taken into account in selecting patients for MitraClip. Here, we present a review of the literature available on the treatment of complex and challenging lesions.

P923Feasibility of the transcatheter mitral valve repair as the rescue therapy for patients with severe mitral regurgitation and endangered heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W M Huang ◽  
C W Lee ◽  
S H Sung ◽  
H C Chang
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiogenic Shock ◽  
Mitral Valve Repair ◽  
Right Atrial ◽  
Heart Team ◽  
Severe Mitral Regurgitation ◽  
Valve Repair ◽  
Term Survival ◽  
Surgical Risk

Abstract Background For those who carry high or prohibitive surgical risk, the transcatheter edge-to edge mitral valve repair using MitraClip has been a safe and effective treatment for severe mitral regurgitation (MR). In patients with severe MR and cardiogenic shock under hemodynamic supporting devices, emergent surgical mitral valve interventions carry extremely high risk for peri-operative morbidities and mortalities. The feasibility and efficacy of emergent MitraClip to rescue patients in critical conditions remains elucidate. Methods Patients with severe MR were evaluated by the heart team and those with high or prohibitive surgical risks were referred to receive MitraClip procedures. Emergent MitraClip were conducted in patients with unstable hemodynamics and under mechanical or inotropic support. The hemodynamic measures, transthoracic echocardiography, transesophageal echocardiography, and blood tests were performed before MitraClip procedures. Procedural success was defined as having mild mitral regurgitation immediately after MitraClip, and patients were free from in-hospital mortality. Clinical and echocardiographic outcomes were followed by telephones and clinics. Results Among 50 consecutive patients (74.7±11.2 years, 74% male), 8 emergent MitraClip procedures were conducted to rescue patients with cardiogenic shock. Extracorporeal membrane oxygenation were used in 2 patients and intra-aortic balloon pump were applied in 4 patients (50%). The rest of 4 patients received continuous inotropic agent administration. Compare to those who underwent elective procedures, patients underwent emergent MitraClip had higher surgical risk profile (Euroscore II 34.8% vs 5.1% and STS score 19.7% vs 5.1%), poorer renal function and higher right atrial pressure. There was no peri-procedural death, myocardial infarction, stroke or any adverse events requiring emergent cardiac surgery in both groups. Mild mitral regurgitation was achieved in 87.5% patients from the emergent group and 95.2% patients in the elective group (P=0.514). In follow up, there were 5 deaths (three in the emergent group), including 2 non-cardiovascular deaths. The Kaplan-Meier analysis showed patients who underwent emergent procedures have poorer long-term survival rate as compare to those who received elective procedures. (P value = 0.008). Conclusions When open-heart surgery is not feasible and deferred due to excessive risk, trans-catheter mitral valve repair is an alternative way to rescue patients in cardiogenic shock status. The emergent MitraClip procedure may provide comparable safety and efficacy in treating patients with severe MR and unstable hemodynamics.

scholarly journals Residual mitral regurgitation impact on outcomes after mitraclip therapy: five-year follow-up from the GRASP registry

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
AM Caggegi ◽  
P Capranzano ◽  
S Scandura ◽  
S Mangiafico ◽  
G Castania ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
Valve Repair ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Mitraclip Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background – Although percutaneous mitral valve repair is an attractive alternative treatment option for patients with severe mitral regurgitation (MR) at high surgical risk, residual MR is commonly observed after the procedure and little is known about its impact on outcomes after MitraClip therapy, expecially in patients with severe left ventricular (LV) impairment. Purpose – The aim of this prospective, observational study was to evaluate the impact of residual MR (MR ≤1+ vs. MR >1+) on long-term outcomes of mitral valve repair with the MitraClip System in high surgical risk patients presenting with moderate-to-severe or severe MR and with severe reduction of LV ejection fraction (EF). Methods – Patients enrolled in the prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) with functional MR and EF ≤30% who were eligible at almost five-year follow-up were included in the present analysis.  The primary endpoint was death at 5-year follow-up.  Also echocardiographic parameters at baseline and 5-year follow-up and rehospitalization rates were assessed. Results – A total of 139 patients were included: 92 (66.2%) with post-procedural residual MR ≤1+ and 47 (33.8%) with residual MR > 1+ (41 patients with residual MR 2+, 5 with residual MR 3+, 1 with residual MR 4+).  Comparable clinical and echocardiographic baseline characteristics were observed between the two groups except for NYHA functional class IV and implanted pace-maker (more frequent in patients with residual MR >1+) and previous myocardial infarction (more frequent  in patients with residual MR ≤1+). At 5-year follow-up, no significant differences were reported in the primary endpoint (49.6% in patients with residual MR ≤ 1+ vs. 65.3% in patients with residual MR > 1+, p 0.203) and in cardiac death (37.8% in patients with residual MR ≤ 1+ vs. 42.6% in patients with residual MR > 1+, p 0.921). Cox regression analysis identified residual MR > 1+ as an independent predictor of re-hospitalization (HR 0.51, 95% CI 0.28-0.92, p =0.026). At 5-year follow-up,  a significant reduction in left ventricular end-systolic volume was  observed in patients with residual MR ≤ 1+. Conclusions – At 5-year follow no significant differences in survival emerged in patients with severe  LV dysfunction undergoing MitraClip therapy regardless residual MR. Nevertheless residual MR > 1+ emerged as an indipendent predictor of re-hospitalization.

scholarly journals P1320 Percutaneous mitral valve leaflet plication to reduce systolic anterior motion and mitral regurgitation using the transcatheter mitral clip system

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Drakopoulou ◽  
S Soulaidopoulos ◽  
G Oikonomou ◽  
K Stathogiannis ◽  
K Aggeli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Significant Coronary Artery Disease ◽  
Mitral Valve Regurgitation ◽  
Left Ventricular ◽  
Heart Team ◽  
Severe Mitral Regurgitation ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Mitral Valve Leaflet

Abstract A 72-year-old female patient with a past medical history of severe mitral regurgitation, atrial fibrillation and embolic cerebrovascular events was admitted to our institution. The patient was under optimal medical therapy and complained for progressive worsening of activity-related dyspnea with limitation of physical activity (NYHA III). Transthoracic echocardiography showed the presence of severe mitral regurgitation with a central jet. There was prolapse of both mitral valve leaflets and interestingly the anterior leaflet presented systolic anterior motion (SAM) at the same time. There was no significant left ventricular outflow tract obstruction (LVOT). Further evaluation of the regurgitant mitral valve with a transesophageal echocardiography (TOE) confirmed the above findings and the mechanism of MV regurgitation was attributed to prolapse in addition to SAM of an elongated anterior leaflet. Laboratory test showed elevated NT-pro-BNP levels. A coronary angiography was performed and excluded significant coronary artery disease. The findings were assessed by our institution’s HEART TEAM and, in the presence of high surgical risk (LogEuroscore 32,76%), a decision for transcatheter mitral valve repair with a Mitral Clip implantation was taken. The Mitral Clip was succesfully implanted with immediate significant reduction of the regurgitant jet and no signs of stenotic behavior of the repaired valve. There was only mild mitral valve regurgitation. Notably, after the procedure there was elimination of the SAM and no LVOT obstruction (Figure). In accordance to the echocardiography findings, the patient demonstrated a significant clinical improvement and was discharged home 1 day after the procedure. Mitral clip implantation in this case showed improvement of the MR by reducing the SAM of the mitral valve. Abstract P1320 Figure.

scholarly journals P1560 Acute changes of mitral annular dimensions after transcatheter egde-to-edge repair: an indirect annuloplasty method?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Papadopoulos ◽  
I Ikonomidis ◽  
M Chrissoheris ◽  
A Chalapas ◽  
P Kourkoveli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Heart Team ◽  
Severe Mitral Regurgitation ◽  
Reduced Ejection Fraction ◽  
Device Implantation ◽  
Percentage Difference ◽  
Before And After ◽  
Acute Changes ◽  
The Impact

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe and alternative method for treating high-risk patients with severe mitral regurgitation (DMR or FMR). This transcatheter treatment aims at reducing the MR with a so-called "Alfieri stitch" method. However the impact on mitral annular dimensions after the device implantation is not well defined. The purpose of this study is to recognize the acute changes of mitral annular dimensions after transcatheter edge-to-edge repair. Methods We retrospectively analyzed 20 consecutive patients (aged 74 ± 10yrs) with degenerative or functional moderate-to-severe and severe mitral regurgitation (EROA 40.8 ± 20.5mm2, RV 52.6 ± 17.5ml) and reduced ejection fraction (EF 36.9 ± 15.4%). These patients were at high surgical risk or even inoperable in certain cases (logistic EuroSCORE 28.9 ± 18.2%) and evaluated by a heart team as candidates for transcatheter repair. All intraoperative transoesophageal echo studies were post processed with EchoPac v.203 or QLAB 9.0. 3D views of the mitral valve before and after the implantation of the device were analyzed with 4D AutoMVQ (GE) or MVQ (Phillips) software. Results PMVR was effective in treating the MR at the end of the operation (from 3.8 ± 0.4 to 1.3 ± 0.5 after the implantation, p < 0.05) in all patients. There was a significant reduction of the annulus area (from 12.25 ± 3.0cm2 to 10.18 ± 2.88cm2, p < 0.001) and circumference (from 13.23 ± 1.4cm to 12.18 ± 1.57cm, p < 0.001), in both DMR and FMR cases. The percentage reduction of annulus area and circumference after PMVR was 17.3 ± 0.8% and 8 ± 5% respectively and the number of the clips used for that purpose were 1.55 ± 0.6. Additionally, edge-to-edge repair significantly reduced the anterior-posterior diameter (from 3.49 ± 0.56cm to 3.02 ± 0.55cm, r = 0.86, p < 0.001) and the posteromedial-anterolateral diameter (from 4.15 ± 0.58cm to 3.88 ± 0.60cm, r = 0.9, p < 0.001). The number of the clips used did not play an important role in the percentage difference of the annulus dimensions (20% reduction with one clip vs 14.3 ± 7.6% with two or more, p < 0.05) and one possible explanation could be that patients receiving one clip had smaller annulus area comparing to the patients receiving two or more (11.2 ± 2.9mm2 vs 13.3 ± 2.7mm2 respectively, p < 0.05). Conclusions Transcatheter edge-to-edge repair is effective in treating MR in patients with DMR and FMR and has a direct impact on mitral annular dimensions acutely after the implantation.

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