Percutanenous Therapies for Mitral Regurgitation

Change in Mitral Annular Size and Geometry after MitraClip® Implantation in Patients with Functional and Degenerative Mitral Regurgitation

“…[2][3][4][5] Although EVEREST enrolled primarily patients with degenerative mitral regurgitation (DMR), in current clinical practice, the majority of patients selected for MitraClip 1 implantation have functional mitral regurgitation (FMR). 6,7 Patients undergoing surgical repair usually undergo concomitant reductive annuloplasty to restore a normal annular-to-leaflet relation, especially when annulus areas are large. Percutaneous approaches to mimic surgical annuloplasty have been explored but are not routine clinical practice.…”

Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model

“…This will be particularly relevant given the development of trans-catheter mitral annuloplasty devices that could ultimately be used in conjunction with the LPC. 23 …”

MitraClip for the treatment of mitral regurgitation

“…On one hand, although APS rates are uniformly reported to be high, MR tends to recur in a substantial proportion of patients, and approximately one quarter of patients are found to have recurrent moderate-tosevere or severe MR on mid-term follow-up. This suggests that in these patients, the edge-to-edge repair of the mitral valve may have failed to address to principal morphologic aetiology of MR. As percutaneous techniques continue to evolve [20,21], it can be envisaged that the future of percutaneous MVR may consist of a combination of devices to address the entire complexity of the mitral valve. A combination of one or more MitraClips with an anuloplasty or LV cinching device [48,49] could simultaneously correct anular dilation and tethering of the subvalvular apparatus, reduce restrictive leaflet motion and re-establish leaflet coaptation.…”

“…Nonetheless, many patients that may potentially benefit from MVR, are currently denied surgery because of a high surgical risk, advanced age or comorbidities [18]. Thus, a variety of transcatheter techniques for the treatment of MR have been proposed to avoid the risks of surgery, and some of them are currently undergoing preclinical or clinical evaluation [19][20][21]. Amongst these techniques, percutaneous edge-to-edge MVR using the MitraClip (Abbott Vascular, Abbott Park, Illinois, USA; formerly manufactured by Evalve Inc, Menlo Park, California, USA) is one of the most promising with encouraging results obtained from several single-centre and multi-centric registries and a first randomised trial.…”

“…Amongst these techniques, percutaneous edge-to-edge MVR using the MitraClip (Abbott Vascular, Abbott Park, Illinois, USA; formerly manufactured by Evalve Inc, Menlo Park, California, USA) is one of the most promising with encouraging results obtained from several single-centre and multi-centric registries and a first randomised trial. However, its role in the started experimenting with percutaneous techniques for MVR [20]. He learned of the Alfieri surgical edgeto-edge mitral repair technique which involves the use of a suture to approximate the edges of the regurgitant mitral valve leaflets thereby restoring leaflet coaptation and creating a double-orifice mitral valve [22].…”