Successful MitraClip Research Articles

Cardiac magnetic resonance imaging in patients undergoing percutaneous mitral valve repair with the MitraClip system

Percutaneous mitral valve repair (MVR) with the MitraClip(®) system in patients with mitral regurgitation (MR) is known to reduce symptoms and to improve cardiac morphology and function. MitraClip has been approved for cardiac magnetic resonance imaging (MRI). To date, however, no systematic analysis exists on cardiac MRI in patients undergoing the MitraClip procedure. The aim of this study was to (1) prove feasibility and robustness of cardiac MRI and (2) visualize effects of the procedure on cardiac morphology and function by cardiac MRI. 27 consecutive patients (age 77.5 ± 7.6 years) with symptomatic moderate to severe MR undergoing the MitraClip(®) procedure were prospectively included. Cardiac MRI at 1.5 T was performed before and at 3 months after intervention. Cardiac morphology and function were evaluated using steady-state free precession (SSFP) cine sequences by assessment of left ventricular enddiastolic and endsystolic diameters (LVEDD, LVESD) and volumes (EDV, ESV), ejection fraction (LVEF) and stroke volume (SV), diameter of mitral annulus, and myocardial mass (MM). Planimetry of the left atrium (LA) was performed in identical slices in a four-chamber view. Around the clip an extinction artifact was observed which did not disturb the evaluation of cardiac morphology and function. At follow-up, we observed significant decreases of LVEDD (58.0 to 53.3 mm, p < 0.0001), EDV (167 to 159 mL, p = 0.0006) and ESV (101 to 89 mL, p < 0.0001), diameter of mitral annulus (41.4 to 37.9 mm, p < 0.0001), myocardial mass (148.4 to 144.5 g, p = 0.0004) and LA size (40.2 to 37.6 cm(2), p < 0.0001). LVEF improved (43.3 to 46.7 %, p = 0.0041). Cardiac MRI is feasible and robust in patients with MitraClips. The clinical benefit of a successful MitraClip intervention is paralleled by significant improvements of cardiac morphology and function which can be monitored and validated using MRI in clinical follow-up examinations.

Redo MitraClip mitral valve repair after a late single leaflet detachment

Percutaneous mitral valve repair with the MitraClip® (Abbott, Abbott Park, IL) can reduce mitral regurgitation (MR) and improve symptoms and quality of life in patients with severe mitral regurgitation. While this therapy is safe, there have been reports of single leaflet detachment where the MitraClip remains attached only to one leaflet of the mitral valve after deployment. Most of these cases occur within the first month of the procedure but there have been reports of late detachment occurring after this period. This case report describes a patient with severe functional MR who underwent an initial successful MitraClip procedure with implantation of two clips but subsequently developed late detachment of one clip. It also discusses the challenges and feasibility of performing a repeat MitraClip procedure in these patients.

Two-year outcome according to renal function of patients not amenable to surgery undergoing successful MitraClip therapy

Two-year outcome according to renal function of patients not amenable to surgery undergoing successful MitraClip therapy

Aetiology of mitral regurgitation differentially affects 2‐year adverse outcomes after MitraClip therapy in high‐risk patients

To assess, and identify predictors of 2-year adverse outcomes of surgical high-risk patients after successful MitraClip therapy (MC), differentiated by the aetiology of mitral regurgitation (MR). Kaplan-Meier analysis was used to assess survival free from death, heart failure rehospitalization, and reintervention up to 2 years in 202 successfully treated patients [74 ± 9 years, 132 men (65%); secondary MR aetiology in 140 patients, primary MR in 62]. Predictors for study endpoints were determined using Cox regression analyses. Mortality was 20% at 1 year and 33% at 2 years in both primary and secondary MR patients; independent predictors of death were reduced forward stroke volume, impaired LV function, and renal failure in primary MR, yet only an increased logistic EuroSCORE in functional MR patients. The rate of rehospitalizations was not different between the patient subgroups for 6 months, but then diverged significantly in favour of primary MR patients (estimated 2-year incidence, primary MR 40% vs. secondary MR 66%). No predictor was found for primary MR patients, but increased LV end-diastolic volume significantly increased the risk of rehospitalization in functional MR patients. Reinterventions were overall rare (7.4% at 1 year, 9.7% at 2 years); primary MR patients required all except one reintervention within 2 months of MC, with again no predictors found, whereas secondary MR patients (all except one with discharge MR of 2+) exhibited a steadily declining freedom from reintervention curve throughout follow-up. MR aetiology affects rehospitalization and reintervention, but not mortality, differently after successful MC.

Percutaneous mitral valve repair with MitraClip for severe functional mitral regurgitation

A 67-year-old Chinese woman with comorbidities of chronic obstructive lung disease, hypertension and prior coronary artery bypass surgery presented with severe functional mitral regurgitation (MR) and severely depressed left ventricular function. She was in New York Heart Association (NYHA) Class II-III. Due to high surgical risk, she was referred for percutaneous treatment with the MitraClip valve repair system. This procedure is typically performed via the femoral venous system and involves a transseptal puncture. A clip is delivered to grasp the regurgitant mitral valve leaflets and reduce MR. This was performed uneventfully in our patient, with reduction of MR from 4+ to 1+. She was discharged on post-procedure Day 2 and her NYHA class improved to Class I. This was the first successful MitraClip procedure performed in Asia and represents a valuable treatment option in patients with severe MR, especially those with functional MR or those at high surgical risk.

TCT-783 Successful MitraClip Therapy in Elderly Patients not Amenable to Surgery: Serial Assessment of Echocardiographic and Clinical Variables out to 2 Years

Background: MitraClip (MC) implantation has recently become a percutaneous option to safely treat grade 3 /4 mitral regurgitation (MR); long-term data are still scarce. In patients not amenable to surgery, we assessed pertinent echocardiographic and clinical variables out to 24 months after successful (discharge MR 2 ) MC therapy. Methods: Of 311 consecutive patients with 3 /4 MR (54%/46%) treated at our center, 2-year follow-up (FU) was due by July 1, 2012, in 133 successfully treated patients. Forty-one (31%) of these patients had died before FU. Of 92 surviving patients, 83 (74 9 years; 52 [63%] men; 57 [69%] with functional MR) were followed for a median of 23.8 [IQR, 22.1 – 24.9] months. Transthoracic echo data as well as 6-minute walk distance (6MWD) and Minnesota (MLHFQ) quality-of-life score were assessed at baseline (BL), discharge (D; echo only), 6, 12, and 24 months. Results: Significant reductions vs. BL were observed at D in regurgitant volume, left ventricular (LV) end-diastolic volume, stroke volume, and LV ejection fraction, but not LV end-systolic volume; all variables remained unchanged at subsequent dates. Forward stroke volume (FSV) increased gradually from 45 ml (BL) to reach a plateau of 55 ml by 6 months (Figure, panel A). Similar improvements were observed for 6MWD (Figure, panel B) and MLHFQ score.

Successful MitraClipTM implantation in a 15-year-old patient with multiple prior cardiac surgeries

Percutaneous edge-to-edge mitral valve repair using the MitraClip(TM) has not been used in children. The patient in this reported case was a 15-year-old male adolescent who presented postnatally with severe aortic valve stenosis and dysplasia of the mitral valve. The boy underwent surgical valvuloplasty at the age of 3 months and an aortoventriculoplasty with three re-operations. At the age of 15 years, he developed severe mitral valve regurgitation. Owing to high surgical risks, a MitraClip(TM) was implanted with a reduction of mitral regurgitation from grade 4+ to 2+, translating into a rapid clinical improvement.

The Acute Hemodynamic Effects of MitraClip Therapy

The objective of this study was to evaluate the acute hemodynamic consequences of mitral valve (MV) repair with the MitraClip device (Abbott Vascular, Menlo Park, California). Whether surgical correction of mitral regurgitation (MR) results in a low cardiac output (CO) state because of an acute increase in afterload remains controversial. The acute hemodynamic consequences of MR reduction with the MitraClip device have not been studied. We evaluated 107 patients with cardiac catheterization before and immediately following percutaneous MV repair with the MitraClip device. In addition, pre- and post-procedural hemodynamic parameters were studied by transthoracic echocardiography. MitraClip treatment was attempted in 107 patients, and in 96 (90%) patients, a MitraClip was deployed. Successful MitraClip treatment resulted in: 1) an increase in CO from 5.0 ± 2.0 l/min to 5.7 ± 1.9 l/min (p = 0.003); 2) an increase in forward stroke volume (FSV) from 57 ± 17 ml to 65 ± 18 ml (p < 0.001); and 3) a decrease in systemic vascular resistance from 1,226 ± 481 dyn·s/cm(5) to 1,004 ± 442 dyn·s/cm(5) (p < 0.001). In addition, there was left ventricular (LV) unloading manifested by a decrease in LV end-diastolic pressure from 11.4 ± 9.0 mm Hg to 8.8 ± 5.8 mm Hg (p = 0.016) and a decrease in LV end-diastolic volume from 172 ± 37 ml to 158 ± 38 ml (p < 0.001). None of the patients developed acute post-procedural low CO state. Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR.

TCT-107: EVEREST II Randomized Clinical Trial: Clinical Benefit by MR Grade in Patients One Year following Successful MitraClip Therapy

TCT-107: EVEREST II Randomized Clinical Trial: Clinical Benefit by MR Grade in Patients One Year following Successful MitraClip Therapy

TCT-82: Successful MitraClip® Therapy Results in Favorable Septo-Lateral Mitral Annular Diameter and Left Ventricular Remodeling in High Risk Surgical Patients with Functional Mitral Regurgitation

TCT-82: Successful MitraClip® Therapy Results in Favorable Septo-Lateral Mitral Annular Diameter and Left Ventricular Remodeling in High Risk Surgical Patients with Functional Mitral Regurgitation