MitraClip for severe symptomatic mitral regurgitation in patients at high surgical risk

Abstract

Background: The optimal treatment of patients with severe mitral regurgitation (MR) at high surgical risk (HSR) is unknown. Recently, the EVEREST II (Endovascular Valve Edgeto-Edge Repair) High Risk Study suggested MitraClip (MC) was a safe and effective treatment option. Methods: We performed a search strategy for MC or mitral valve surgery (MVS) in patients at HSR for surgical mortality (logistic EuroSCORE >18 or STS score > 10) using Medline databases, proceedings of international meetings, and the STS database. We identified 21 studies utilizing MC (n 5 3,198) and MVS (n 5 3,265, >90% from the STS database) from 2003 to 2013. Information about patient characteristics, surgical risk, and 30-day and 1-year outcomes were extracted. Results: Patients who underwent MC or MVS had a mean age of 74 6 10 years with no differences in surgical risk, NYHA class, or MR grade (P 5 0.46). Technical success was achieved in 96% of patients undergoing MC versus 98% in the MVS group (P 5 0.45). Patients undergoing MC were treated with one or two MC in 90% (n 5 2,878) with only a few requiring repeat MC (0.4%, n 5 13) or mitral surgery (0.3%, n 5 52) at 30 days. The pooled event rates for mortality was 3.2% (95% CI [2.5-4.2]), stroke was 1.1% (95% CI [0.7-0.2]) at 30 days. At 31 days to 1 year, the pooled event rate for mortality was 13.0% [95% CI (9-18.3)], stroke was 1.6% [95% CI (0.8-3.2)], and repeat MVS was 1.3% [95% CI (0.7-2.6)] with the majority of patients in the mild/moderate MR grade and NYHA class after MC. The 30-day event rates for mortality and stroke were 16.8% (95% CI [14][15][16][17][18][19]) and 4.5% (95% CI [3.9-5.3]) after MVS, respectively. Conclusion: Based on high risk MC studies and high risk MVS data predominantly from STS database, patients with severe MR who are at HSR can be effectively treated with MC or MVS. MC can be safely implanted in high risk patients with relatively low mortality and stroke risk. V C 2014 Wiley Periodicals, Inc.

The mitral‐to‐aortic flow‐velocity integral ratio in the real world echocardiographic evaluation of functional mitral regurgitation before and after percutaneous repair

“…Functional mitral regurgitation (FMR) is a common finding in patients with left ventricular dysfunction and its severity, as known, represents an important prognostic factor in patients with heart failure with reduced ejection fraction (HFrEF) . This evidence has aroused interest around minimally invasive procedures able to reduce significantly the mitral regurgitation severity in patients with high surgical risk profile, such as HFrEF population. Percutaneous mitral repair (PMVR) using the MitraClip™ system is emerged in last years as a reliable, safe, and cost‐effective treatment option for FMR in this setting.…”

Transcathether Valve Replacement and Valve Repair

“…84 Since the EVEREST trials, however, numerous case reports and observational studies have shown that realworld patients are different and can be successfully treated with this technology. 79 transmitral mean pressure gradient ≥4 mm Hg as independently predictive of clip failure, and a native mitral valve area ≤3.0 cm 2 and a transmitral mean pressure gradient ≥4 mm Hg as independently predictive of procedure abortion. Table 3 lists ideal and challenging echocardiographic parameters for the MitraClip.…”

“…[79][80][81][82] Delivered to the left atrium by a 24 Fr femoral venous delivery sheath, the cobalt chromium, polyester-covered MitraClip grasps and approximates the edges of opposing mitral leaflet segments. This results in a double orifice similar to the Alfieri stitch.…”

Invasive Treatment in Advanced (Stage-D) Heart Failure

“…To increase utilization of the MitraClip treatment, this new approach must be used in selective cases or as an earlier step before the destination therapy. The first 30 days have an acceptable course, but after that the frequency of adverse events increases, especially early recurrence/persistence of MR [38].…”