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Percutaneous treatment of mitral regurgitation with MitraClip device.

Pregowski J, Witkowski A - Postepy Kardiol Interwencyjnej (2013)

Bottom Line: The results of the randomized EVEREST II study showed a favourable safety profile of the technique.However, the efficacy in terms of regurgitation reduction in a population with predominantly degenerative mitral disease was inferior as compared to the results of conventional open heart surgery.The registry data suggest that the minimally invasive and generally well-tolerated MitraClip procedure reduces symptoms and need for recurrent hospitalization and improves left ventricular function in inoperable subjects.

View Article: PubMed Central - PubMed

Affiliation: Cardiology and Invasive Angiology Department, Institute of Cardiology, Warsaw, Poland.

ABSTRACT
The percutaneous edge-to-edge repair of mitral regurgitation with a MitraClip device has been recently approved in Europe. The results of the randomized EVEREST II study showed a favourable safety profile of the technique. However, the efficacy in terms of regurgitation reduction in a population with predominantly degenerative mitral disease was inferior as compared to the results of conventional open heart surgery. Nevertheless, up to 50% of symptomatic heart failure patients with severe mainly functional mitral regurgitation are not treated surgically because of very high procedural risk. The registry data suggest that the minimally invasive and generally well-tolerated MitraClip procedure reduces symptoms and need for recurrent hospitalization and improves left ventricular function in inoperable subjects. The ongoing randomized clinical trials with clinical endpoints will further define the current role of percutaneous edge-to-edge repair in heart failure patients with mitral regurgitation.

No MeSH data available.


Related in: MedlinePlus

Angiographic images of the MitraClip device recorded during the procedure. A – The TEE probe, B – the MitraClip system during positioning in the left ventricle, C – the clip immediately after implantation, still connected by a tiny line to the delivery system, D – two clips implanted, final effect of the procedure
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Figure 0002: Angiographic images of the MitraClip device recorded during the procedure. A – The TEE probe, B – the MitraClip system during positioning in the left ventricle, C – the clip immediately after implantation, still connected by a tiny line to the delivery system, D – two clips implanted, final effect of the procedure

Mentions: Mitral regurgitation is the second most frequent valve disease requiring surgical treatment in Europe [1]. Open heart surgery with valve repair is the gold standard for the correction of mitral regurgitation, especially in patients with degenerative valve disease [2]. However, up to 50% of patients with heart failure symptoms and severe mitral regurgitation are not treated surgically because of prohibitive procedural risk related to numerous comorbidities in this population [3]. Therefore, several minimally invasive devices were introduced or are currently being tested clinically in order to develop the optimal technique minimizing the procedure-related risk of mitral valve repair. The most advanced project of minimally invasive percutaneous mitral valve repair is based on the concept of the cardiac surgeon Ottavio Alfieri, who developed the technique of edge-to-edge valve repair [4, 5]. Briefly, the middle scallops of anterior and posterior leaflets (A2 and P2) are sutured together to reduce regurgitation and create a double orifice mitral valve during diastole. Following positive results of Alfieri's technique in selected patients, the percutaneously deployed mechanical implant MitraClip was designed [6–8]. The MitraClip system mirrors the surgical procedure in permanent approximation of valve leaflets. A detailed description of the MitraClip system was published previously [6–9]. The implant is introduced through the guide catheter (24 Fr) using the femoral vein access. After transseptal puncture the system is positioned in the left atrium and left ventricle to adequately grasp the leaflets with the clip. The procedure is performed in general anaesthesia under fluoroscopy with continuous transoesophageal echocardiography guidance and requires close cooperation between the operator and the echocardiographers. Images of the whole system, the clip and typical echocardiographic projections are presented in Figures 1 and 2.


Percutaneous treatment of mitral regurgitation with MitraClip device.

Pregowski J, Witkowski A - Postepy Kardiol Interwencyjnej (2013)

Angiographic images of the MitraClip device recorded during the procedure. A – The TEE probe, B – the MitraClip system during positioning in the left ventricle, C – the clip immediately after implantation, still connected by a tiny line to the delivery system, D – two clips implanted, final effect of the procedure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927113&req=5

Figure 0002: Angiographic images of the MitraClip device recorded during the procedure. A – The TEE probe, B – the MitraClip system during positioning in the left ventricle, C – the clip immediately after implantation, still connected by a tiny line to the delivery system, D – two clips implanted, final effect of the procedure
Mentions: Mitral regurgitation is the second most frequent valve disease requiring surgical treatment in Europe [1]. Open heart surgery with valve repair is the gold standard for the correction of mitral regurgitation, especially in patients with degenerative valve disease [2]. However, up to 50% of patients with heart failure symptoms and severe mitral regurgitation are not treated surgically because of prohibitive procedural risk related to numerous comorbidities in this population [3]. Therefore, several minimally invasive devices were introduced or are currently being tested clinically in order to develop the optimal technique minimizing the procedure-related risk of mitral valve repair. The most advanced project of minimally invasive percutaneous mitral valve repair is based on the concept of the cardiac surgeon Ottavio Alfieri, who developed the technique of edge-to-edge valve repair [4, 5]. Briefly, the middle scallops of anterior and posterior leaflets (A2 and P2) are sutured together to reduce regurgitation and create a double orifice mitral valve during diastole. Following positive results of Alfieri's technique in selected patients, the percutaneously deployed mechanical implant MitraClip was designed [6–8]. The MitraClip system mirrors the surgical procedure in permanent approximation of valve leaflets. A detailed description of the MitraClip system was published previously [6–9]. The implant is introduced through the guide catheter (24 Fr) using the femoral vein access. After transseptal puncture the system is positioned in the left atrium and left ventricle to adequately grasp the leaflets with the clip. The procedure is performed in general anaesthesia under fluoroscopy with continuous transoesophageal echocardiography guidance and requires close cooperation between the operator and the echocardiographers. Images of the whole system, the clip and typical echocardiographic projections are presented in Figures 1 and 2.

Bottom Line: The results of the randomized EVEREST II study showed a favourable safety profile of the technique.However, the efficacy in terms of regurgitation reduction in a population with predominantly degenerative mitral disease was inferior as compared to the results of conventional open heart surgery.The registry data suggest that the minimally invasive and generally well-tolerated MitraClip procedure reduces symptoms and need for recurrent hospitalization and improves left ventricular function in inoperable subjects.

View Article: PubMed Central - PubMed

Affiliation: Cardiology and Invasive Angiology Department, Institute of Cardiology, Warsaw, Poland.

ABSTRACT
The percutaneous edge-to-edge repair of mitral regurgitation with a MitraClip device has been recently approved in Europe. The results of the randomized EVEREST II study showed a favourable safety profile of the technique. However, the efficacy in terms of regurgitation reduction in a population with predominantly degenerative mitral disease was inferior as compared to the results of conventional open heart surgery. Nevertheless, up to 50% of symptomatic heart failure patients with severe mainly functional mitral regurgitation are not treated surgically because of very high procedural risk. The registry data suggest that the minimally invasive and generally well-tolerated MitraClip procedure reduces symptoms and need for recurrent hospitalization and improves left ventricular function in inoperable subjects. The ongoing randomized clinical trials with clinical endpoints will further define the current role of percutaneous edge-to-edge repair in heart failure patients with mitral regurgitation.

No MeSH data available.


Related in: MedlinePlus