Transcatheter Procedure for Residual Mitral Regurgitation After MitraClip Implantation Using Amplatzer Duct Occluder II

Kubo, Shunsuke; Cox, Justin; Mizutani, Yukiko; Uberoi, Abhimanyu; Chakravarty, Tarun; Nakajima, Yoshifumi; Hussaini, Asma; Tat, Emily; Makar, Moody; Kar, Saibal

doi:10.1016/j.jcin.2016.03.011

Cited by 21 publications

(20 citation statements)

References 16 publications

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“…Additional percutaneous technologies like direct percutaneous annuloplasty (Cardioband, Valtech Cardio, Or Yehuda, Israel) are currently entering the market and may also become feasible options for a transcatheter redo repair, especially in patients with further annular dilatation due to a progressive disease . Specific defects like regurgitant flows between two clips, may be amenable to plugging with Amplatzer Duct Occluders (St. Jude Medical, Minneapolis, MN) . However, experience with these technologies is still limited.…”

Section: Discussionmentioning

confidence: 99%

Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome

Curio

Reinthaler

Kasner

et al. 2017

J Interven Cardiology

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Section: Discussionmentioning

confidence: 99%

Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome

Curio

Reinthaler

Kasner

et al. 2017

J Interven Cardiology

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“…This may be of benefit if there is a large cleft. However, there have been theoretic concerns about occluder stability compared to the ADO . The AVP II occluders all had a stable position in our case series.…”

Section: Hybrid Approach With Mitraclip and Avp II Occludermentioning

confidence: 72%

A hybrid technique for treatment of commissural primary mitral regurgitation

Raphael

Malouf

Maor

et al. 2018

Cathet Cardio Intervent

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Background MitraClip is an effective transcatheter therapy for mitral regurgitation (MR). However, MitraClip is challenging in commissural MR and the optimal therapeutic approach is unclear. Methods We describe a case series of six consecutive patients with severe commissural primary mitral regurgitation who underwent MitraClip insertion followed by an Amplatzer Vascular Plug (AVP) II occluder between the commissure and the MitraClip. Results The procedure was successful in all patients. MR was reduced from severe to mild/trivial in 50% and moderate in 50% of cases. On 30‐day follow‐up, NYHA class had improved from III (6 patients) to I (2 patients), II (2 patients), and III (2 patients). The mean transmitral gradient was 2.5 ± 1.8 mmHg at baseline and 4.8 ± 2.6 mmHg following the procedure. One patient developed hemolysis immediately post procedure. The other five patients remained well during a median follow‐up of 20 months (range 5–50 months) with no reported device dislodgement. Conclusions Elective treatment of severe commissural MR with a laterally or medially placed MitraClip coupled with an AVP II occluder between the clip and the commissure is feasible and safe. This approach may provide a useful management alternative in selected patients.

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“…The management of residual MR following a MitraClip procedure can often be a challenging problem . Use of additional clips or occluder devices are effective in selected cases . Selection of the occluder devices depends on the size, position, and characteristics of the residual MR jet.…”

Section: Discussionmentioning

confidence: 99%

“…Deployment of additional clips or in some instances deployment of plugs between clips has been used to optimize results. Specifically, there have been reports of the usage of the Amplatzer Occluder devices (St Jude Medical), between clips or between a clip and commissure for the treatment of residual MR . These devices are made of nitinol mesh, which can be easily delivered but are associated with residual leaks through the mesh and in some instances intravascular hemolysis.…”

Section: Introductionmentioning

confidence: 99%

First experience of the usage of a GORECARDIOFORMSeptal Occluder device for treatment of a significant residual commissural mitral regurgitation jet following a MitraClip procedure

Nakajima

Kar

2017

Cathet Cardio Intervent

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An 81-year-old male presented with symptomatic recurrent MR following a MitraClip procedure using two clips. After adding another clip, there was still a residual jet medially. We plugged the gap using 12-mm AMPLATZER Muscular VSD Occluder device (St. Jude Medical, Minneapolis, MN). MR was reduced but hemolysis occurred. We retrieved the VSD Occluder device to improve hemolysis, but the MR jet worsened to severe, so we placed a 30-mm GORE CARDIOFORM Septal Occluder device. The device was stable, the MR jet was reduced dramatically, and hemolysis was not observed. Materials of these devices are mesh fabric made from nitinol and polyester in a VSD Occluder device and expanded polytetrafluoroethylene in GORE CARDIOFORM Septal Occluder device. The difference between device materials affects flow pattern of residual jet and hemolysis. In conclusion, the patient's risk for hemolysis is potentially affected by the occluder or plug material. GORE CARDIOFORM is a feasible choice to reduce the risk of hemolysis in a selected patient.

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Transcatheter Procedure for Residual Mitral Regurgitation After MitraClip Implantation Using Amplatzer Duct Occluder II

Abstract: Transcatheter deployment of the ADO II plug was effective for the reduction of residual commissural MR and intraclip MR after MitraClip implantation. The potential role of this technique should be established for challenging cases.

Cited by 21 publications

References 16 publications

Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome

Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome

A hybrid technique for treatment of commissural primary mitral regurgitation

First experience of the usage of a GORECARDIOFORMSeptal Occluder device for treatment of a significant residual commissural mitral regurgitation jet following a MitraClip procedure

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