Percutaneous Repair of Mitral Regurgitation with the MitraClip® System

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Complications related to the procedure were quite low, especially when one considers that this cohort included the earliest procedures at each institution. There were no deaths, and 97% of patients were discharged without the need for home healthcare. The rate of 30-day major adverse events, not including blood transfusion, was 3%. Although there were no cases of clip embolization, partial clip detachment occurred in nine patients (9%), but all cases occurred within the first 30 days and were managed successfully with elective surgery. Acute procedural success, defined as a successful clip implantation with core echocardiographic laboratory assessment of MR <2+ at discharge, was achieved in 85% of this initial cohort of patients. Follow-up of these patients demonstrated a durable result in the majority of patients to three years (see Figure 3). In addition, significant reverse left ventricular remodeling confirmed that a benefit of MR reduction was achieved.12

Discussion

Use of the MitraClip system to repair mitral regurgitation on a beating heart without surgery is feasible, safe, and effective. Keys to the success of this procedure include careful patient selection and a collaborative interdisciplinary team approach with echocardiographer, anesthesiologist, and interventionalist. Future refinements in both the technology and imaging are likely to improve efficacy and further simplify the procedure. Realtime 3D transesophageal imaging has recently become available.13 With this technique, improved visualization of the MitraClip delivery system can be achieved, providing the interventionalist with an ‘en-face’ or ‘surgeon’s view’ of the mitral apparatus and allowing the operator to better co-ordinate steering of the device in 3D space (see Figure 4). Ôûá

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References
  1. Enriquez-Sarano M, Avierinos JF, Masika-Zeitoun D, et al., New Eng J Med, 2005;352:875–83.
    Crossref | PubMed
  2. Bonow RO, Carabello BA, Chatterjee K, et al., Circulation, 2006;114:e84–231.
    Crossref | PubMed
  3. Goodney PP, Stukel TA, Lucas FL, et al., Hospital Volume, Ann Surg, 2003;238:161–7.
    Crossref | PubMed
  4. David TE, Semin Thorac Cardiovasc Surg, 2007;19:116–20.
    Crossref | PubMed
  5. Feldman T, Leon MB, Circulation, 2007;116:2866–77.
    Crossref | PubMed
  6. Herrmann HC, Feldman T, Euro Intervention, 2006;1(Suppl. A): A36–9.
  7. Maisano F, Caldarola A, Blasio A, et al., J Thorac Cardiovasc Surg, 2003;126:1987–97.
    Crossref | PubMed
  8. Silvestry FE, Rodriguez L, Herrmann HC, et al., J Am Soc Echocardiog, 2007;20:1131–40.
    Crossref | PubMed
  9. Foster E,Wasserman HS, Gray W, et al., Am J Cardiol, 2007;100:1577–83.
    Crossref | PubMed
  10. Feldman T,Wasserman HS, Herrmann HC, et al., J Am Coll Cardiol, 2005;46:2134–40.
    Crossref | PubMed
  11. Feldman T, Foster E, Tunuguntla A, et al., J Am Coll Cardiol, 2007;49(Suppl. A):310A.
  12. Carabello BA, Kar S, Rinaldi M, et al., Circulation, 2007;116 (Suppl. 2):357.
  13. O’Gara P, Sugeng L, Lang R, et al., J Am Coll Cardiol Img, 2008;1:221–37.
    Crossref