Impact of MitraClip™ therapy on secondary mitral valve surgery in patients at high surgical risk

Conradi, Lenard; Treede, Hendrik; Franzen, Olaf; Seiffert, Moritz; Baldus, Stephan; Schirmer, Johannes; Meinertz, Thomas; Reichenspurner, Hermann

doi:10.1016/j.ejcts.2011.03.007

Cited by 17 publications

(14 citation statements)

References 12 publications

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“…3 However, the indications for MitraClip implantation should be discussed carefully beforehand, because when MitraClip therapy fails, the patient's pathologic valvular condition can worsen so substantially that valve replacement becomes necessary. Patients with degenerated leaflets are poor candidates for MitraClip therapy.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The stated advantage of this technique is to preserve the option of surgical repair after a failed attempt at device placement or when MR recurs after MitraClip implantation. 3 However, it is unclear what side effects clipping might have on the mitral tissues. 4 As MitraClip usage increases, so does the frequency of clip failure and the consequent need for surgical treatment.…”

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confidence: 99%

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Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy

Monsefi¹,

Zierer²,

Khalil³

et al. 2014

Texas Heart Institute Journal

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The MitraClip percutaneous mitral valve repair system, developed as an option for percutaneous mitral repair, was clinically introduced in 2007. From 2010 through 2012, 6 of our patients underwent mitral valve surgery after MitraClip failure. Their mean age was 75 ± 7.7 years (range, 62–87 yr). Three had undergone cardiac surgery previously. In 5 of the 6 patients, mitral regurgitation recurred after initially successful MitraClip deployment and was the indication for surgery. The mean interval between MitraClip implantation and surgery was 106 ± 86 days (range, 0–238 d). Mitral valve repair was feasible in 3 patients; the others underwent valve replacement. All the patients underwent additional cardiac procedures, because the MitraClip worsened existing conditions. Echocardiograms revealed sufficient valvular repairs. Two patients died during hospitalization, one of cerebral infarction and the other of bowel ischemia. Mitral valve repair after failed MitraClip therapy can be complex and a surgical challenge. Careful consideration should be given to appropriate patient selection for MitraClip therapy, because the MitraClip can cause existing pathologic valvular conditions to deteriorate substantially. The interval between MitraClip failure and corrective surgery should be as short as possible. The primary indication is an issue of ongoing discussion.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy

Monsefi¹,

Zierer²,

Khalil³

et al. 2014

Texas Heart Institute Journal

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“…Therefore, a debate is ongoing about the durability of interventional edge-to-edge repair using the MitraClip in such patients because of its limited effect on the MV leaflets. 2,3 Only limited data are available on acute changes of the MV annular geometry after MitraClip implantation. 4 We hypothesized that interventional edge-to-edge repair of MR using the MitraClip system potentially reduces MV annular diameters because of immediate and persistent tension on the MV annulus via the anterior and posterior (AP) MV leaflets.…”

mentioning

confidence: 99%

Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease

Schueler

Momčilović

Weber

et al. 2014

Circ: Cardiovascular Interventions

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Background-Transcatheter mitral valve repair (TMVR) is a treatment option in patients with symptomatic functional or degenerative mitral regurgitation (DMR) at high surgical risk. The acute effect of MitraClip procedure on mitral valve (MV) annular geometry and its relation to functional outcomes is unclear. We sought to assess immediate effect of TMVR on MV annular geometry with 3-dimensional (3D) transesophageal echocardiography and the association of MV diameter reduction with functional response after 6 months. , and MV annular geometry (MV sphericity index, 0.9±0.1 and 0.8±0.1; P<0.0001); the lateral medial MV diameters remained unchanged (4.3±0.7 and 4.4±0.6 cm; P=0.13). In subjects with DMR, all MV annular geometry-defining values were not significantly altered after TMVR (n=36; P>0.05). Acute anterior-posterior diameter reduction was associated with clinical response to TMVR after 6 months of follow-up (cutoff value, ≥6.4%; area under the curve, 0.81; P=0.002; sensitivity, 81.6%; specificity, 81.8%), which was confirmed by additional regression analysis (P=0.007). Conclusions-Three-dimensional transesophageal echocardiography enables assessment of acute changes of MV geometry in patients undergoing the MitraClip procedure. Only patients with functional mitral regurgitation experienced significant reduction of MV annular dimensions, which was associated with clinical response to TMVR. (Circ Cardiovasc Interv. 2014;7:390-399.) Methods and Results-Consecutive

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“…In the early postoperative course, the MAE Multimorbidity, high-risk patient, contraindication for oMVS: log EuroScore > 20% and/or STS-Score >10% 11,13,14,19,21,24,26,31,35,42,43,48,49 AHA/ASC/ESC criteria for oMVS fulfilled [10][11][12]20,21,38,40,43,45,47,50 Previous cardiac surgery 13,14,20,26,40,45 Echocardiographic criteria for treatment with MitraClip system fulfilled 8,9,19,32,33 Chest radiation/porcelain aorta 8,9,16,26,45,51 Possible indications…”

Section: Recommendations For Structural Procedural and Documentatiomentioning

confidence: 99%

The MitraClip System: A Systematic Review of Indications, Procedural Requirements, and Guidelines

Bail

Doebler

2013

Thorac cardiovasc Surg

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Background Transcatheter interventions (TIs) are new treatment options for patients with severe mitral valve regurgitation (MR) who cannot undergo open mitral valve surgery (oMVS). Despite the lack of scientific evidence demonstrating the benefit of these procedures, there has been a steady increase in their use. The aim of this study was to evaluate whether there are any indication criteria, process, and structural requirements, or scientific society and institutional guidelines for the use of the MitraClip System (Abbott Vascular-Structural Heart, Menlo Park, California, United States). Method A systematic literature search was conducted using the common medical and scientific databases. Of a total of 1,395 publications, 42 publications met the inclusion criteria and were included for the evaluation. Results Despite a general lack of high-quality evidence and of consensus recommendations from scientific societies or institutions, an assessment of indication criteria and process and structural requirements for the use of the MitraClip System, including noncontrolled studies, was possible. The majority of studies agree that an interdisciplinary heart team including a cardiothoracic surgeon, an interventional cardiologist, and an echocardiographic specialist should actively participate in clinical decision making, and in the procedure itself. Participation in a scientific-based registry is strongly recommended. Conclusions The MitraClip System is a promising procedure, but evidence-based indication criteria, structural, and process requirements for its use are lacking. Further results from prospective, randomized controlled trials are needed to determine patients, potential adverse events, device durability, and long-term follow-up. MitraClip should be used in only a small number of centers with procedure-specific, high-quality surgical and interventional experience, and training.

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Impact of MitraClip™ therapy on secondary mitral valve surgery in patients at high surgical risk

Cited by 17 publications

References 12 publications

Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy

Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy

Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease

The MitraClip System: A Systematic Review of Indications, Procedural Requirements, and Guidelines

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