Assessment of the MitraClip Procedure: Reassessing the Goals

Abstract

THE MITRACLIP (Abbott Laboratories) was first implanted in 2003, was approved in Europe in 2008, and approved by the US Food and Drug Administration in 2013. The MitraClip procedure has reduced hospitalization and mortality compared to medical therapy, with either improved or similar outcomes compared with isolated mitral valve surgery. 1 Shah MA Dalak FA Alsamadi F et al. Complications following percutaneous mitral valve edge-to-edge repair using MitraClip. J Am Coll Cardiol. 2021; 3: 370-376 Google Scholar , 2 Stone GW Lindenfeld JA Abraham WT et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018; 379: 2307-2318 Crossref PubMed Scopus (1514) Google Scholar , 3 Stone GW Adams DH Abraham WT et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: Part 2: Endpoint definitions a consensus document from the mitral valve academic research consortium. J Am Coll Cardiol. 2015; 66: 308-321 Crossref PubMed Scopus (302) Google Scholar In the earlier and preliminary data, proponents of surgery highlighted less mitral regurgitation (MR) and fewer additional procedures after surgical correction of MR; however, the overall major cardiac adverse events were significantly lower (15% v 48%) for percutaneous procedures. 4 Feldman T Foster E Glower DD et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011; 364: 1395-1406 Crossref PubMed Scopus (1475) Google Scholar Since the initial experiences, all outcomes for MitraClip procedures have improved with greater experience. 5 Chhatriwalla AK Vemulapalli S Holmes DR et al. Institutional experience with transcatheter mitral valve repair and clinical outcomes. J Am Coll Cardiol. 2019; 12: 1342-1352 Crossref Scopus (100) Google Scholar Right Ventricular Failure in Emergent MitraClip Therapy—A Problem Worth InvestigatingJournal of Cardiothoracic and Vascular AnesthesiaPreviewThe MitraClip (Abbott, Santa Clara, CA) has emerged as a safe, effective, and durable treatment for hemodynamically significant mitral regurgitation (MR) refractory to maximally tolerable guideline-directed medical therapy in nonsurgical patients.1-9 Hemodynamically, the MitraClip reduces left ventricular volumes, unloads the left atrium and pulmonary circulation, reduces right ventricular afterload (as long as iatrogenic MitraClip-induced mitral stenosis does not develop), and facilitates biventricular reverse remodeling. Full-Text PDF Invited Commentary: “Assessment of the MitraClip procedure: Reassessing the goals”Journal of Cardiothoracic and Vascular AnesthesiaPreviewAsher and colleagues1 present two interesting cases that not only highlight the use of MitraClip in the urgent setting, but also how intraoperative case management can help facilitate procedural success. Mitral valve disease is one of the most common valvular disorders with an incidence anywhere from 10% to 24%, most commonly affecting people older than 75 years.2,3 Primary mitral regurgitation (MR) is due to a structural or degenerative abnormality while secondary MR is related to left ventricular (LV) or less commonly left atrial disease. Full-Text PDF