Mitral clip: A novel percutaneous approach to mitral valve repair. Review of prince sultan cardiac center experience

Abstract

Mitral clip procedure is an evolving and promising therapeutic intervention which is helpful for patients with symptomatic significant mitral regurgitation (MR) and with very high surgical risk in addition to its role as palliative measure until definitive treatment. Transesophageal echocardiography (TEE) plays a key role in assessing suitability and it is an essential modality during the different stages of the procedure. Our series includes thirteen (13) patients of significant symptomatic MR. Eight (8) were males (62%), five (5) were females (38%). Age ranges from 45 to 95. Average is 55. The patients were representing 4 different aetiologies of MR (76.9% were functional MR). Ischemic cardiomyopathy represented the majority of our patients (53%) with EF ranging from 20% to 30% and MR span from moderately severe to severe. There were three (3) cases of non-ischemic cardiomyopathy (23%) with EF ranging from 25% to 30% and MR of moderately severe to severe. Degenerative MR was represented by two (2) cases 15% of moderately severe MR and EF of 45–50%. There was one (1) case (7%) of flail severe MR and EF of 55%. One (1) was aborted due to complication during trans septal puncture. The clip was implanted successfully in 100% of the cases. All patients were followed up with symptoms and clinical status scrutiny as well as echo predischarge, 1 month and 3 months post procedure. Mitral regurgitation improved 2–3 grades in 6 patients (46%) with significant improvement in symptomatology. Three (3) patients exhibited 1 grade improvement in MR (23%) with limited if any symptomatic improvement and two (2) patients (15%) remains with severe MR. It appears to be a promising technique to improve MR grade and symptomatology in significant number of patients. However, the small number of patients and the short period of follow-up stand against strict conclusions about the clinical value of the procedure.