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Managing mitral regurgitation: focus on the MitraClip device.

Magruder JT, Crawford TC, Grimm JC, Fredi JL, Shah AS - Med Devices (Auckl) (2016)

Bottom Line: This catheter-based system has been widely demonstrated to be safe, although inferior to surgical MVR.MitraClip therapy also appears to reduce heart failure readmissions in the high-risk cohort, which may lead to an economic benefit.Ongoing study is needed to clarify the impact of percutaneous mitral valve clipping on long-term survival in high-risk populations, as well as its role in other patient populations, such as those with functional MR.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, Nashville, TN, USA.

ABSTRACT
Based on the principle of surgical edge-to-edge mitral valve repair (MVR), the MitraClip percutaneous MVR technique has emerged as a minimally invasive option for MVR. This catheter-based system has been widely demonstrated to be safe, although inferior to surgical MVR. Studies examining patients with ≥3+ mitral regurgitation (MR) show that, for all patients treated, freedom from death, surgery, or MR ≥3+ is in the 75%-80% range 1 year following MitraClip implantation. Despite its inferiority to surgical therapy, in high-risk surgical patients, data suggest that the MitraClip system can be employed safely and that it can result in symptomatic improvement in the majority of patients, while not precluding future surgical options. MitraClip therapy also appears to reduce heart failure readmissions in the high-risk cohort, which may lead to an economic benefit. Ongoing study is needed to clarify the impact of percutaneous mitral valve clipping on long-term survival in high-risk populations, as well as its role in other patient populations, such as those with functional MR.

No MeSH data available.


Related in: MedlinePlus

Schematic diagram of two methods of mitral valve repair.Notes: (A) ring annuloplasty (gray shaded ring, secured with sutures). (B) Alfieri edge-to-edge repair (ie, mid-leaflet plication as shown with Xs to denote suture placement across both leaflets.Abbreviations: A, anterior mitral leaflet; P, posterior mitral leaflet.
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f1-mder-9-053: Schematic diagram of two methods of mitral valve repair.Notes: (A) ring annuloplasty (gray shaded ring, secured with sutures). (B) Alfieri edge-to-edge repair (ie, mid-leaflet plication as shown with Xs to denote suture placement across both leaflets.Abbreviations: A, anterior mitral leaflet; P, posterior mitral leaflet.

Mentions: The history of the MitraClip begins with advances made in the surgical treatment of MR. For at least two decades, it has become clear that for most patients, mitral repair (rather than replacement) provides superior outcomes at lower risk.2,3 Traditionally, repair has been performed via ring annuloplasty based on the seminal work of Dr Carpentier and others,4,5 but other techniques have been proposed (Figure 1). The MitraClip technology draws on experience with the edge-to-edge MVR, first described by Dr Alfieri in the 1990s.6 This technique, first employed in patients with single or bileaflet prolapse, involves the placement of suture to anchor the free edge of the prolapsed leaflet to its corresponding opposite leaflet. Alfieri’s simple method results in the creation of two valve orifices if prolapse occurs in the middle portion of a leaflet, or a smaller valve orifice should the lesion be pericommissural.7 This “double-orifice” technique omitted annuloplasty. In his original series, Alfieri documented rates of survival and freedom from reoperation to be above 90% over 5 years after MVR using his technique.6


Managing mitral regurgitation: focus on the MitraClip device.

Magruder JT, Crawford TC, Grimm JC, Fredi JL, Shah AS - Med Devices (Auckl) (2016)

Schematic diagram of two methods of mitral valve repair.Notes: (A) ring annuloplasty (gray shaded ring, secured with sutures). (B) Alfieri edge-to-edge repair (ie, mid-leaflet plication as shown with Xs to denote suture placement across both leaflets.Abbreviations: A, anterior mitral leaflet; P, posterior mitral leaflet.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835144&req=5

f1-mder-9-053: Schematic diagram of two methods of mitral valve repair.Notes: (A) ring annuloplasty (gray shaded ring, secured with sutures). (B) Alfieri edge-to-edge repair (ie, mid-leaflet plication as shown with Xs to denote suture placement across both leaflets.Abbreviations: A, anterior mitral leaflet; P, posterior mitral leaflet.
Mentions: The history of the MitraClip begins with advances made in the surgical treatment of MR. For at least two decades, it has become clear that for most patients, mitral repair (rather than replacement) provides superior outcomes at lower risk.2,3 Traditionally, repair has been performed via ring annuloplasty based on the seminal work of Dr Carpentier and others,4,5 but other techniques have been proposed (Figure 1). The MitraClip technology draws on experience with the edge-to-edge MVR, first described by Dr Alfieri in the 1990s.6 This technique, first employed in patients with single or bileaflet prolapse, involves the placement of suture to anchor the free edge of the prolapsed leaflet to its corresponding opposite leaflet. Alfieri’s simple method results in the creation of two valve orifices if prolapse occurs in the middle portion of a leaflet, or a smaller valve orifice should the lesion be pericommissural.7 This “double-orifice” technique omitted annuloplasty. In his original series, Alfieri documented rates of survival and freedom from reoperation to be above 90% over 5 years after MVR using his technique.6

Bottom Line: This catheter-based system has been widely demonstrated to be safe, although inferior to surgical MVR.MitraClip therapy also appears to reduce heart failure readmissions in the high-risk cohort, which may lead to an economic benefit.Ongoing study is needed to clarify the impact of percutaneous mitral valve clipping on long-term survival in high-risk populations, as well as its role in other patient populations, such as those with functional MR.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, Nashville, TN, USA.

ABSTRACT
Based on the principle of surgical edge-to-edge mitral valve repair (MVR), the MitraClip percutaneous MVR technique has emerged as a minimally invasive option for MVR. This catheter-based system has been widely demonstrated to be safe, although inferior to surgical MVR. Studies examining patients with ≥3+ mitral regurgitation (MR) show that, for all patients treated, freedom from death, surgery, or MR ≥3+ is in the 75%-80% range 1 year following MitraClip implantation. Despite its inferiority to surgical therapy, in high-risk surgical patients, data suggest that the MitraClip system can be employed safely and that it can result in symptomatic improvement in the majority of patients, while not precluding future surgical options. MitraClip therapy also appears to reduce heart failure readmissions in the high-risk cohort, which may lead to an economic benefit. Ongoing study is needed to clarify the impact of percutaneous mitral valve clipping on long-term survival in high-risk populations, as well as its role in other patient populations, such as those with functional MR.

No MeSH data available.


Related in: MedlinePlus