MitraClip step by step; how to simplify the procedure

Sherif, Mohammad; Paranskaya, Liliya; Yuecel, Seyrani; Kische, Stephan; Thiele, Olga; D’Ancona, Giuseppe; Neuhausen-Abramkina, A.; Ortak, Jasmin; İnce, Hüseyin; Öner, Alper

doi:10.1007/s12471-016-0930-7

Cited by 46 publications

(23 citation statements)

References 16 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Procedural details of TMVR with the MitraClip system have been described previously [14,15]. During the MitraClip procedure, acute changes of MR severity were assessed by intraprocedural transesophageal echocardiography as supposed by Armstrong and Foster [16], and Wunderlich and Siegel [17].…”

Section: Interventional Edge-to-edge Repair Of Mrmentioning

confidence: 99%

Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

et al. 2021

View full text Add to dashboard Cite

Background: The MitraClip procedure was established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, the aim was to evaluate 5-year outcomes after MitraClip. Methods: Consecutive patients undergoing the MitraClip system were prospectively included. All patients underwent clinical follow-up and transthoracic echocardiography. Results: Two hundred sixty-five patients (age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60.5% secondary MR [sMR]). Although high procedural success of 91.3% was found, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04). Five years after the MitraClip procedure, the majority of patients presented with reduced symptoms and improved functional capacity (functional NYHA class: p = 0.0001; 6 minutes walking test: p = 0.04). Sustained MR reduction (≤ grade 2) was found in 74% of patients, and right ventricular (RV) function was significantly increased (p = 0.03). Systolic pulmonary artery pressure (sPAP) was significantly reduced during follow-up only in sMR patients (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, 5-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (MVG) (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality. Conclusions: Transcatheter mitral valve repair with the MitraClip system showed low complication rates and sustained MR reduction with improved RV function and sPAP 5 years after the procedure was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher 5-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and 5-year mortality. (Cardiol J XXXX; XX, X: xx-xx)

show abstract

Section: Interventional Edge-to-edge Repair Of Mrmentioning

confidence: 99%

Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The surgery can be performed through conventional sternotomy or right anterolateral mini-thoracotomy with an excellent long-term outcome and high repair rates [3, 4]. In 2007, the percutaneous mitral valve repair via the MitraClip system was introduced in clinical use for high-risk surgical patients [5, 6]. In these high-risk patients, percutaneous mitral valve intervention showed effective reduction of mitral regurgitation [7].…”

Section: Introductionmentioning

confidence: 99%

Failed MitraClip therapy: surgical revision in high-risk patients

Mkalaluh

Szczechowicz

Kretzler

et al. 2019

J Cardiothorac Surg

View full text Add to dashboard Cite

Background MitraClip implantation is a valid interventional option that offers acceptable short-term results. Surgery after failed MitraClip procedures remains challenging in high-risk patients. The data on these cases are limited by the small sample numbers. Aim The aim of our study is to show, that mitral valve surgery could be possible and more advantageous, even in high-risk patients. Methods Between 2010 and 2016, nine patients underwent mitral valve surgery after failed MitraClip therapy at our institution. Results The patients’ ages ranged from 19 to 75 years (mean: 61.2 ± 19.6 years). The median interval between the MitraClip intervention and surgical revision was 45 days (range: 0 to 1087 days). In eight of nine patients, the MitraClip intervention was initially successful and the mitral regurgitation was reduced. Only one patient had undergone cardiac surgery previously. Intra-operatively, leaflet perforation or rupture, MitraClip detachment, and chordal or papillary muscle rupture were potentially the causes of recurrent mitral regurgitation. There were three early deaths. One year after surgery, the six remaining patients were alive. Conclusions Mitral valve surgery can be successfully performed after failed MitraClip therapy in high-risk patients. The initial indication for MitraClip therapy should be considered carefully for possible surgical repair.

show abstract

“…Some have advocated that topology of the TSP site may be important to facilitate different procedures, e.g ., posteroinferior region for PVI, center or inferior aspect of the septum for LAA occlusion, and superior and posterior-mid aspect of the fossa ovalis for the MitraClip, but site-specific TSP is usually not necessary for other types of LA procedures [ 60 , 61 ]. Nevertheless, guiding by echo imaging is important when this is deemed necessary, particularly for mitral valve techniques [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

Transseptal Access to the Left Atrium: Tips and Tricks to Keep it Safe Derived from Single Operator Experience and Review of the Literature

Manolis¹

2017

CCR

View full text Add to dashboard Cite

Background: Transseptal puncture (TSP) remains a demanding procedural step in access-ing the left atrium with inherent risks and safety concerns, mostly related to cardiac tamponade.Objective: Based on our own experience with 249 TSP procedures and in-depth literature review, we present our results and offer several tips and tricks that may render TSP successful and safe.Methods: This prospective study comprised 249 consecutive patients (146 men), aged 41.6+17.4 years, undergoing TSP by a single operator for ablation of a variety of arrhythmias, mostly related to left accessory pathways (n=145) or left atrial tachycardias (n=33) and more recently, atrial fibrillation (n=70). TSP was guided by fluoroscopy alone in all patients without the use of echocardiography im-aging. In addition, an extensive literature review of TSP-related topics was carried out in PubMed, Scopus and Google Scholar.Results: Among 249 patients, 33 patients were children or young adolescents (aged 7-18 years); 14 patients were undergoing a repeat procedure. Patients with a manifest accessory pathway were the youngest (mean age 33.7+15.9) and patients with atrial fibrillation the oldest (mean age 56.0+10.8 years). A successful TSP was accomplished in 247 patients (99.2%). Two (0.8%) procedures were complicated by cardiac tamponade managed successfully with pericardiocentesis or surgical drainage. Review of the literature revealed no systematic reviews and meta-analyses of TSP studies; however, several patient series have documented that fluoroscopy-guided TSP, with various modifications in the technique employed in the present series, have been effective in 95-100% of the cases with a complication rate ranging from 0.0% to 6.7%, albeit with a mortality rate of 0.018%-0.2%. Echo im-aging techniques were employed in cases with difficult TSP.Conclusion: Employing a standardized protocol with use of fluoroscopy alone minimized serious complications to 0.8% (2 patients) among 249 consecutive patients undergoing TSP for ablation of a variety of cardiac arrhythmias. Based on this single-operator experience and review of the literature, a list of practical tips and tricks is provided for a successful and safe procedure, reserving the more ex-pensive and patient inconveniencing echo-imaging techniques for difficult or failed cases.

show abstract

MitraClip step by step; how to simplify the procedure

Cited by 46 publications

References 16 publications

Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

Failed MitraClip therapy: surgical revision in high-risk patients

Transseptal Access to the Left Atrium: Tips and Tricks to Keep it Safe Derived from Single Operator Experience and Review of the Literature

Contact Info

Product

Resources

About