Abstract
The MitraClip system is a device for percutaneous edge-to-edge reconstruction of the mitral valve in patients with severe mitral regurgitation who are deemed at high risk for surgery. Studies have underlined the therapeutic benefit of the MitraClip system for patients at extreme and high risk for mitral valve surgery, suffering from either degenerative or functional mitral regurgitation. The MitraClip procedure shows low peri-procedural complication rates, and a significant reduction in mitral regurgitation, as well as an improvement in functional capacity and most importantly quality of life. It hereby widens the spectrum of mitral valve repair for the Heart Team. The current review underscores the efficacy of the procedure and describes the technique to simplify the procedure.
Highlights
The MitraClip (Abbott Laboratories, Menlo Park, California, USA) is a catheter-based technology that is similar to the Alfieri technique in that it connects the middle scallops of the anterior and the posterior leaflet of a regurgitantA large prospective, nonrandomised European study, ACCESS-EU found 81.8% survival at 1 year and 78.9% freedom from severe mitral regurgitation (MR) [5]
A similar study, the RESHAPE-HF trial (Randomized Study of the MitraClip Device in Heart Failure Patients With Clinically Significant Functional Mitral Regurgitation), is enrolling patients with severe functional MR and a left ventricular ejection fraction of 15–40%, deemed non-surgical candidates who will be randomised to MitraClip therapy versus medical management
In this review we describe the technical aspects of the MitraClip procedure
Summary
The MitraClip (Abbott Laboratories, Menlo Park, California, USA) is a catheter-based technology that is similar to the Alfieri technique in that it connects the middle scallops of the anterior and the posterior leaflet of a regurgitant. The COAPT trial (Clinical Outcomes Assessment of MitraClip Percutaneous Therapy), a prospective, randomised, parallel controlled study, is currently enrolling patients with severe functional MR and heart failure (left ventricular ejection fraction 20–50%). A similar study, the RESHAPE-HF trial (Randomized Study of the MitraClip Device in Heart Failure Patients With Clinically Significant Functional Mitral Regurgitation), is enrolling patients with severe functional MR and a left ventricular ejection fraction of 15–40%, deemed non-surgical candidates who will be randomised to MitraClip therapy versus medical management. Patients with a flail or prolapse distance greater than 1 cm width along the line of coaptation or greater than 1 cm into the left atrium do not meet the criteria for clip procedure and are likely to have poor procedural success [10]. The clip delivery system can be introduced through the guide catheter (Fig. 1)
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