Mitral valve transcatheter edge-to-edge repair

Abstract

Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER. KEYWORDS• acute heart failure • chronic heart failure • mitral regurgitation • TEER • transcatheter edge-to-edge repair

One‐Year Outcomes According to Mitral Regurgitation Etiology Following Transcatheter Edge‐to‐Edge Repair With the PASCAL System: Results From a Multicenter Registry

“… 26 An anatomic reanalysis of patients with DMR with residual MR 3+/4+ (Table S2 ) revealed a high proportion of anatomies considered complex or very complex such as Barlow disease, noncentral pathology, or small mitral valve area. 23 Most recently, the CLASP IID registry, investigating the PASCAL system in DMR with anatomically complex mitral valve anatomy, demonstrated MR reduction to ≤2+ in 92.4% and ≤1+ in 56.1% (paired analysis) at 6 months, being more comparable with our results than the results of the randomized trial. The CLASP IID registry included patients that were not eligible for randomization within the CLASP IID randomized trial due to anatomic criteria outside of the traditional instructions for use criteria of the MitraClip system.…”

“… 20 , 21 , 22 It may be speculated that the novel features of the PASCAL system such as the central spacer and the shaped paddles may be beneficial in FMR patients in which the mitral leaflets often experience tethering and therefore more tension. 21 , 23 Moreover, the possibility of independent leaflet grasping may have provided an advantage over the third‐generation MitraClip system, allowing more stable positioning of the device. 24 …”

“… 9 It should be noted that these criteria have been surpassed in daily clinical practice in experienced centers for years and even the complex cases included in the CLASP IID registry are most likely not representative for the prevalence of complex DMR anatomies in the real world. 23 , 26 …”

Outcomes of Transcatheter Edge-to-Edge Repair in Patients With Chronic Kidney Disease: A Retrospective National Inpatient Sample Study

“…TEER is a percutaneous procedure that utilizes the Mitra-Clip device to approximate and fuse the anterior and posterior leaflets of the mitral valve, subsequently reducing the regurgitant volume. TEER, however, is not without complications [ 6 ].…”

First in‐human experience of miniaturized 4D‐TOE probe supporting M‐TEER

“…| 1145 TOE probes as they still offer superior imaging definition. Current experience in LAAO and interatrial septum interventions suggests that a good imaging quality with standard-TOE translates into a good imaging quality for 4D mini-TOE probe: therefore, standard TOE is probably the best screening tool to determine anatomical challenges and image quality.An experienced interventional team is mandatory and the evaluation of the anatomical complexity represents an essential step: beginning to treat patients with "noncomplex mitral regurgitation"4 will increase the technical experience and will enable the development of technical skills to deal with more difficult scenarios. In any case, at the present moment, the evidence is too scarce to support a general use and like other practical tools, daily practice and frequent usage will determine the limitations and advantages of the technology.CONFLICT OF INTEREST STATEMENTXavier Freixa is a proctor for Abbott and LifeTech Science.…”