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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 of MitraClip device insertion.Notes: (A) Device inserted to right atrium, ready to cross atrial septum. (B) Septum traversed, and device curving inferiorly to pass through mitral orifice. (C) MitraClip in place to arrest leaflets. (D) Successful MitraClip capture of leaflets (clip shown closed so as to reapproximate mid-leaflets).Abbreviations: C, MitraClip catheter; MC; MitraClip clip; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; MV, mitral valve; P, papillary muscles.
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f2-mder-9-053: Schematic of MitraClip device insertion.Notes: (A) Device inserted to right atrium, ready to cross atrial septum. (B) Septum traversed, and device curving inferiorly to pass through mitral orifice. (C) MitraClip in place to arrest leaflets. (D) Successful MitraClip capture of leaflets (clip shown closed so as to reapproximate mid-leaflets).Abbreviations: C, MitraClip catheter; MC; MitraClip clip; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; MV, mitral valve; P, papillary muscles.

Mentions: Based on these findings, investigators at major academic institutions in concert with private industry (Evalve, Redwood City, CA, USA; later Abbot Vascular, Santa Clara, CA, USA) developed a transcatheter method of accomplishing reapproximation of the anterior and posterior mitral leaflets as a therapy for MR. This method was first described in adult pigs in 2003.8 The original device was inserted via the femoral vein and utilized a 24Fr guidewire to gain transseptal access to the left atrium (Figure 2A and B). The tip of this catheter was designed with a bidirectional steering mechanism so it can be positioned centrally above the mitral valve annulus. Once the delivery catheter is in position, a V-shaped clip is introduced while closed. The clip, which is polyester-covered and made of cobalt–chromium, spans about 4 mm when closed, and has a maximum arm excursion of about 20 mm when opened (Figure 2C). The clip is then opened and rotated in the left atrium so as to be perpendicular to the lines of leaflet coaptation, advanced into the left ventricle, and then retracted during systole to snare the anterior and posterior leaflets (Figure 2D). Importantly, the clip can be opened and closed repeatedly to ensure optimal positioning.


Managing mitral regurgitation: focus on the MitraClip device.

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

Schematic of MitraClip device insertion.Notes: (A) Device inserted to right atrium, ready to cross atrial septum. (B) Septum traversed, and device curving inferiorly to pass through mitral orifice. (C) MitraClip in place to arrest leaflets. (D) Successful MitraClip capture of leaflets (clip shown closed so as to reapproximate mid-leaflets).Abbreviations: C, MitraClip catheter; MC; MitraClip clip; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; MV, mitral valve; P, papillary muscles.
© Copyright Policy
Related In: Results  -  Collection

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

f2-mder-9-053: Schematic of MitraClip device insertion.Notes: (A) Device inserted to right atrium, ready to cross atrial septum. (B) Septum traversed, and device curving inferiorly to pass through mitral orifice. (C) MitraClip in place to arrest leaflets. (D) Successful MitraClip capture of leaflets (clip shown closed so as to reapproximate mid-leaflets).Abbreviations: C, MitraClip catheter; MC; MitraClip clip; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; MV, mitral valve; P, papillary muscles.
Mentions: Based on these findings, investigators at major academic institutions in concert with private industry (Evalve, Redwood City, CA, USA; later Abbot Vascular, Santa Clara, CA, USA) developed a transcatheter method of accomplishing reapproximation of the anterior and posterior mitral leaflets as a therapy for MR. This method was first described in adult pigs in 2003.8 The original device was inserted via the femoral vein and utilized a 24Fr guidewire to gain transseptal access to the left atrium (Figure 2A and B). The tip of this catheter was designed with a bidirectional steering mechanism so it can be positioned centrally above the mitral valve annulus. Once the delivery catheter is in position, a V-shaped clip is introduced while closed. The clip, which is polyester-covered and made of cobalt–chromium, spans about 4 mm when closed, and has a maximum arm excursion of about 20 mm when opened (Figure 2C). The clip is then opened and rotated in the left atrium so as to be perpendicular to the lines of leaflet coaptation, advanced into the left ventricle, and then retracted during systole to snare the anterior and posterior leaflets (Figure 2D). Importantly, the clip can be opened and closed repeatedly to ensure optimal positioning.

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