Mitral Valve Repair With the MitraClip®

Michael O Kayatta; Hanna Jensen; Muralidhar Padala; Richard C Gilmore; Vinod H Thourani

Disclosures

Interv Cardiol. 2014;6(6):557-567. 

In This Article

Abstract and Introduction

Abstract

Mitral valve regurgitation is a common disease, traditionally treated with valve repair or replacement using open cardiac surgery. The most common etiologies of mitral regurgitation (MR) include degenerative and functional pathologies. MitraClip® (Abbott Vascular, CA, USA), a new device for transcatheter mitral valve repair, which gained CE mark approval for use in Europe in 2008, is now approved in the USA for use in patients with symptomatic degenerative mitral valve regurgitation who are deemed to be prohibitive risk surgical candidates. For these patients, MitraClip offers a safe and effective treatment option. Currently, trials are underway to assess its efficacy in high surgical risk patients with functional MR. The data from these trials will hopefully provide guidance to physicians to determine which patients would benefit from the device and which patients would benefit from the standard surgical approach. There is evidence that the MitraClip will continue to have an important role in treating both high-risk and nonsurgical patients with degenerative and functional MR now and in the future.

Introduction

Mitral regurgitation (MR), either from primary valve disease (degenerative) or secondary (functional) to left ventricular dysfunction, affects more than 4 million Americans, or almost one in ten people over age 75 years. When moderately severe or severe, MR progresses and results in the deterioration of left ventricular function resulting in congestive heart failure, increased mortality and a significant decrease in quality of life (QoL). Chronic MR also increases the risk of atrial fibrillation and stroke, both of which can have a debilitating impact on patients.[1] Definitive treatment of this problem traditionally requires surgical intervention, either with repair or replacement of the diseased valve through a median sternotomy or a lateral thoracotomy.[2] Minimally invasive open-heart techniques such as endoscopic repair through the right chest or robotic mitral valve repair are available but are less frequently used; all surgical approaches require cardiopulmonary bypass.[3,4]

Given that patients with severe, symptomatic MR often have increased surgical risk due to impaired cardiac function, advanced age and associated comorbidities, newer approaches that do not utilize invasive techniques requiring cardiopulmonary bypass would be welcome. Transcatheter mitral valve repair with MitraClip® (Abbott Vascular, CA, USA) is one such technology that uses femoral venous access to repair the mitral valve without requiring cardiac arrest and is the primary subject of this review.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....