Asian Pacific Society of Cardiology Consensus Recommendations on the Use of MitraClip for Mitral Regurgitation

Abstract

Transcatheter mitral valve repair with the MitraClip, a catheter-based percutaneous edge-to-edge repair technique to correct mitral regurgitation (MR), has been demonstrated in Western studies to be an effective and safe MR treatment strategy. However, randomised clinical trial data on its use in Asian-Pacific patients is limited. Hence, the Asian Pacific Society of Cardiology convened an expert panel to review the available literature on MitraClip and to develop consensus recommendations to guide clinicians in the region. The panel developed statements on the use of MitraClip for the management of degenerative MR, functional MR, and other less common indications, such as acute MR, dynamic MR, hypertrophic obstructive cardiomyopathy, and MR after failed surgical repair. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted ‘agree’ or ‘neutral’. This consensus-building process resulted in 10 consensus recommendations to guide general cardiologists in the evaluation and management of patients in whom MitraClip treatment is being contemplated.

Thirty-day Outcomes of First-in-man Implantation of a Novel Transcatheter Edge-to-edge Mitral Repair System in Patients With Severe Mitral Regurgitation

“…In this study, there was 1 case (a patient with P2 prolapse, 5.6%) of SLDA, possibly due to insufficient leaflet grasping. Similar studies have shown that SLDA is a relatively common complication, [13–15] with an incidence of 11% in the EVEREST I trial and 5.1% in the EVEREST II trial, which may be highly related to the learning curve of the operators. Another clip was applied to stabilize the first SLDA clip that occurred in the patient in this study, which effectively reduced the MR to 1+.…”

Percutaneous Edge-to-Edge Mitral Valve Repair for Functional Mitral Regurgitation

“…Most recently, the 3-year outcomes of the COAPT study were reported which continued to demonstrate durable benefits with TEER in their patient cohort. 33) Firstly, the curves for the composite end-point of all-cause death or HF hospitalization continued to diverge from 2 to 3 years in favour of TEER and GDMT compared to GDMT alone. TEER resulted in a NNT of 3.4 to prevent 1 death or HF hospitalization within 3 years compared to 4.5 within 2 years.…”

Echocardiographic Imaging in Transcatheter Structural Intervention

“…Inspired by the Alfieri stitch technique, MV TEER with the use of the Mitraclip (Abbott) was developed as a less invasive alternative for significant MR in those with prohibitive surgical risk. 5 , 6 , 7 , 18 , 25 , 36 , 37 , 38 Despite initial challenges in Asian countries, the technique has gained traction over the past decade. 5 , 6 , 7 , 36 Key pre- and periprocedural views for assessment include the midesophageal bicommissural and long-axis views ( Table 1 ).…”

“… 5 , 6 , 7 , 18 , 25 , 36 , 37 , 38 Despite initial challenges in Asian countries, the technique has gained traction over the past decade. 5 , 6 , 7 , 36 Key pre- and periprocedural views for assessment include the midesophageal bicommissural and long-axis views ( Table 1 ). Multiplane imaging allows simultaneous display of both views.…”

“… 2 , 3 Interests in the field of TSHI has since spread across the globe, including in Asia, with many regional registries having been developed and guidelines being published as a result. 4 , 5 , 6 , 7 …”