Echocardiographic predictors of single versus dual MitraClip device implantation and long‐term reduction of mitral regurgitation after percutaneous repair

Armstrong, Ehrin J.; Rogers, Jason H.; Swan, Christo H.; Upadhyaya, Deepa; Viloria, Esperanza; McCulloch, Charles E.; Slater, James; Qureshi, Mansoor; Whisenant, Brian; Feldman, Ted; Foster, Elyse

doi:10.1002/ccd.24645

Cited by 22 publications

(17 citation statements)

References 22 publications

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“…Furthermore, the predictive value of these measures is questionable because in clinical practice mainly patients with FMR at high surgical risk undergo MitraClip procedures, which were not investigated rigorously. 4,10 Nevertheless, clinical success rates of MitraClip procedures are consistently reported to be high, ranging between 75% and 95%, [11][12][13] and real-time 3D TEE has been established as an indispensable tool for patient selection, procedural guidance, and the evaluation of acute interventional success. 14 However, acute interventional goals predicting durable device-success are not well defined.…”

Section: Patient Selection and Definition Of Successful Tmvr With Thementioning

confidence: 99%

Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease

Schueler

Momčilović

Weber

et al. 2014

Circ: Cardiovascular Interventions

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Background-Transcatheter mitral valve repair (TMVR) is a treatment option in patients with symptomatic functional or degenerative mitral regurgitation (DMR) at high surgical risk. The acute effect of MitraClip procedure on mitral valve (MV) annular geometry and its relation to functional outcomes is unclear. We sought to assess immediate effect of TMVR on MV annular geometry with 3-dimensional (3D) transesophageal echocardiography and the association of MV diameter reduction with functional response after 6 months. , and MV annular geometry (MV sphericity index, 0.9±0.1 and 0.8±0.1; P<0.0001); the lateral medial MV diameters remained unchanged (4.3±0.7 and 4.4±0.6 cm; P=0.13). In subjects with DMR, all MV annular geometry-defining values were not significantly altered after TMVR (n=36; P>0.05). Acute anterior-posterior diameter reduction was associated with clinical response to TMVR after 6 months of follow-up (cutoff value, ≥6.4%; area under the curve, 0.81; P=0.002; sensitivity, 81.6%; specificity, 81.8%), which was confirmed by additional regression analysis (P=0.007). Conclusions-Three-dimensional transesophageal echocardiography enables assessment of acute changes of MV geometry in patients undergoing the MitraClip procedure. Only patients with functional mitral regurgitation experienced significant reduction of MV annular dimensions, which was associated with clinical response to TMVR. (Circ Cardiovasc Interv. 2014;7:390-399.) Methods and Results-Consecutive

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Section: Patient Selection and Definition Of Successful Tmvr With Thementioning

confidence: 99%

Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease

Schueler

Momčilović

Weber

et al. 2014

Circ: Cardiovascular Interventions

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“…Patients with degenerative MR may have thicker and more mobile leaflets and had (in our cohort) more often severe MR at baseline, which may explain why these patients in particular are treated with ≥2 Clips. A previous study identified anterior leaflet thickness (OR 1.7 per mm [95% CI; 1.16–2.57], p = 0.007) and a greater regurgitation volume at baseline (OR 1.21 per 10 ml [95% CI; 1.0–1.3], p = 0.01) as echocardiographic predictors for the need for more than 1 Clip [11]. Another study showed that the vena contracta (jet width) predicted need for >1 Clip (OR 2.5 [95% CI; 1.2–5.3], p = 0.013) with 83% sensitivity and 90% specificity for a cut-off value of ≥7.5 mm [12].…”

Section: Discussionmentioning

confidence: 99%

Current MitraClip experience, safety and feasibility in the Netherlands

et al. 2017

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PurposeData on MitraClip procedural safety and efficacy in the Netherlands are scarce. We aim to provide an overview of the Dutch MitraClip experience.MethodsWe pooled anonymised demographic and procedural data of 1151 consecutive MitraClip patients, from 13 Dutch hospitals. Data was collected by product specialists in collaboration with local operators. Effect on mitral regurgitation was intra-procedurally assessed by transoesophageal echocardiography. Technical success and device success were defined according to modified definitions of the Mitral Valve Academic Research Consortium (MVARC).ResultsMedian age was 76 (interquartile range 69–82) years and 59% were males. Patients presented with ≥moderate mitral regurgitation and a predominance of functional mitral regurgitation (72%). Overall, 611 (53%) patients were treated with one Clip, 486 (42%) with ≥2 Clips and 54 (5%) received no Clip. The number of patients with ≥2 Clips increased from 22% in 2009 to 52% in 2016. Device success and technical success were 91 and 95%, respectively, and were consistent over the years. Significant reduction of mitral regurgitation by MitraClip was achieved in 94% of patients and was observed more often in patients with functional mitral regurgitation (95% vs. 91%, p = 0.025). Device time declined from 145 min in 2009 to 55 min in 2016.ConclusionMitraClip experience in the Netherlands is growing with excellent technical success and device success. Over the years, device time decreased and more patients were treated with ≥2 Clips.

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“…A European study expanded the use of the clip on an experimental basis to high surgical risk patients, 70% of whom would have been excluded in the original EVEREST trial either because of LV dysfunction or valve anatomy. 66 The therapy was feasible in this cohort without major adverse events. As experience with the device increases, the possibilities of utilization of this percutaneous therapy continue to expand.…”

Section: Future Directionsmentioning

confidence: 98%

Percutaneous Mitral Heart Valve Repair—MitraClip

Doshi

Agrawal²,

Garg³

et al. 2014

Cardiology in Review

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Mitral regurgitation (MR) is the most common cardiac valvular disease in the United States. Approximately 4 million people have severe MR and roughly 250,000 new diagnoses of MR are made each year. Mitral valve surgery is the only treatment that prevents progression of heart failure and provides sustained symptomatic relief. Mitral valve repair is preferred over replacement for the treatment of MR because of freedom from anticoagulation, reduced long-term morbidity, reduced perioperative mortality, improved survival, and better preservation of left ventricular function compared with valve replacement. A large proportion of patients in need of valve repair or replacement do not undergo such procedures because of a perceived unacceptable perioperative risk. Percutaneous catheter-based methods for valvular pathology that parallel surgical principles for valve repair have been developed over the last few years and have been proposed as an alternate measure in high-risk patients. The MitraClip (Abbott Labs) device is one such therapy and is the subject of this review.

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Echocardiographic predictors of single versus dual MitraClip device implantation and long‐term reduction of mitral regurgitation after percutaneous repair

Abstract: Subjects with thicker anterior mitral leaflets and more severe MR were more likely to receive two MitraClip devices. Immediate and long-term reduction in MR was similar regardless of the number of devices implanted at the time of the procedure.

Cited by 22 publications

References 22 publications

Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease

Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease

Current MitraClip experience, safety and feasibility in the Netherlands

Percutaneous Mitral Heart Valve Repair—MitraClip

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