Mitral valve surgery following failed MitraClip implantation

Mazur, Piotr; Mok, Salvior; Krishnaswamy, Amar; Kapadia, Samir; Navia, José L.

doi:10.1111/jocs.12877

Cited by 13 publications

(10 citation statements)

References 38 publications

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“…There are also reports of acute leaflet perforation after MitraClip for FMR. [32] While usually considered a technical complication, acute perforation may be a function of leaflet stress since tissue rupture is more likely at high stress and strain levels. Taken together, these data support the concept that recurrent MR after MitraClip for FMR is impacted by device-induced leaflet stress.…”

Section: Discussionmentioning

confidence: 99%

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

et al. 2019

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PurposeMitraClip is the sole percutaneous device approved for functional mitral regurgitation (MR; FMR) but MR recurs in over one third of patients. As device-induced mechanical effects are a potential cause for MR recurrence, we tested the hypothesis that MitraClip increases leaflet stress and procedure-related strain in sub-valvular left ventricular (LV) myocardium in FMR associated with coronary disease (FMR-CAD).MethodsSimulations were performed using finite element models of the LV + mitral valve based on MRI of 5 sheep with FMR-CAD. Models were modified to have a 20% increase in LV volume (↑LV_VOLUME) and MitraClip was simulated with contracting beam elements (virtual sutures) placed between nodes in the center edge of the anterior (AL) and posterior (PL) mitral leaflets. Effects of MitraClip on leaflet stress in the peri-MitraClip region of AL and PL, septo-lateral annular diameter (SLAD), and procedure-related radial strain (Err) in the sub-valvular myocardium were calculated.ResultsMitraClip increased peri-MitraClip leaflet stress at end-diastole (ED) by 22.3±7.1 kPa (p<0.0001) in AL and 14.8±1.2 kPa (p<0.0001) in PL. MitraClip decreased SLAD by 6.1±2.2 mm (p<0.0001) and increased Err in the sub-valvular lateral LV myocardium at ED by 0.09±0.04 (p<0.0001)). Furthermore, MitraClip in ↑LV_VOLUME was associated with persistent effects at ED but also at end-systole where peri-MitraClip leaflet stress was increased in AL by 31.9±14.4 kPa (p = 0.0268) and in PL by 22.5±23.7 kPa (p = 0.0101).ConclusionsMitraClip for FMR-CAD increases mitral leaflet stress and radial strain in LV sub-valvular myocardium. Mechanical effects of MitraClip are augmented by LV enlargement.

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Section: Discussionmentioning

confidence: 99%

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

et al. 2019

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“…[32] There are also reports of acute leaflet perforation after MitraClip for FMR. [33] While usually considered a technical complication, acute perforation may be a function of leaflet stress since tissue rupture is more likely at high stress and strain levels. Taken together, these data support the concept that recurrent MR after MitraClip for FMR is impacted by device-induced leaflet stress.…”

Section: Mitraclip Durabilitymentioning

confidence: 99%

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Zhang

Wang

Morgan

et al. 2019

Preprint

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Purpose: MitraClip is the sole percutaneous device approved for functional mitral regurgitation (MR; FMR) but MR recurs in over one third of patients. As device-induced mechanical effects are a potential cause for MR recurrence, we tested the hypothesis that MitraClip increases leaflet stress and procedure-related strain in sub-valvular left ventricular (LV) myocardium in FMR associated with coronary disease (FMR-CAD). Methods:Simulations were performed using finite element models of the LV + mitral valve based on MRI of 5 sheep with FMR-CAD. Models were modified to have a 20% increase in LV volume (↑LV_VOLUME) and MitraClip was simulated with contracting beam elements (virtual sutures) placed between nodes in the center edge of the anterior (AL) and posterior (PL) mitral leaflets. Effects of MitraClip on leaflet stress in the peri-MitraClip region of AL and PL, septo-lateral annular diameter (SLAD), and procedurerelated radial strain (Err) in the sub-valvular myocardium were calculated.Results: MitraClip increased peri-MitraClip leaflet stress at end-diastole (ED) by 22.3±7.1 kPa (p<0.0001) in AL and 14.8±1.2 kPa (p<0.0001) in PL. MitraClip decreased SLAD by 6.1±2.2 mm (p<0.0001) and increased Err in the sub-valvular lateral LV myocardium at ED by 0.09±0.04 (p<0.0001)). Furthermore, MitraClip in ↑LV_VOLUME was associated with persistent effects at ED but also at end-systole where peri-MitraClip leaflet stress was increased in AL by 31.9±14.4 kPa (p=0.0268) and in PL by 22.5±23.7 kPa (p=0.0101). Conclusions:MitraClip for FMR-CAD increases mitral leaflet stress and radial strain in LV sub-valvular myocardium. Mechanical effects of MitraClip are augmented by LV enlargement. Abstract Word Count:249 AL P2 Ao MClip A. B. C.

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“…[1][2][3] We now present a case of endocarditis involving both a Mitraclip and an aortic valve prosthesis. [1][2][3] We now present a case of endocarditis involving both a Mitraclip and an aortic valve prosthesis.…”

mentioning

confidence: 99%

“…

The MitraClip system has been associated with injuries to the mitral valve leaflets, the development of mitral stenosis, and endocarditis. [1][2][3] We now present a case of endocarditis involving both a Mitraclip and an aortic valve prosthesis. A 75-year-old male underwent a Bentall (#27 mm St. Jude Medical, Minneapolis, MN) procedure and coronary artery bypass grafting in 1988 followed by the implantation of two MitraClips (Abbott Vascular Inc., Santa Clara, CA) in the A2-P2 segment for functional mitral regurgitation in 2014.

…”

mentioning

confidence: 99%

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Prosthetic valve endocarditis involving the MitraClip device

et al. 2017

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Mitral valve surgery following failed MitraClip implantation

Abstract: Mitral valve disruption is a rare but serious complication of MitraClip insertion. This review provides an update on surgical interventions following MitraClip failure, and discusses possible valve injuries and surgical approaches.

Cited by 13 publications

References 38 publications

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Prosthetic valve endocarditis involving the MitraClip device

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