Percutaneous approaches to mitral valve regurgitation

Abstract

Mitral regurgitation is a common problem associated with significant morbidity and mortality. Mitral valve surgery has been the treatment of choice for symptomatic patients with severe mitral regurgitation or asymptomatic patients with high-risk clinical features. However, a significant number of patients remain untreated related mainly due to a projected high surgical risk. Therefore, alternative percutaneous treatments including indirect annuloplasty, which takes advantage of the coronary sinus, and direct annuloplasty have recently been explored. Most recently, promising results of the first randomized trial comparing conventional mitral valve surgery to percutaneous therapy with a clip creating a double orifice much like the surgical Alfieri approach have been presented. Finally, percutaneous mitral valve replacement in an animal model has been pursued. This review serves to familiarize the reader with some anatomical concepts and devices for percutaneous mitral repair.

Change in Mitral Annular Size and Geometry after MitraClip® Implantation in Patients with Functional and Degenerative Mitral Regurgitation

“…Patients undergoing surgical repair usually undergo concomitant reductive annuloplasty to restore a normal annular‐to‐leaflet relation, especially when annulus areas are large. Percutaneous approaches to mimic surgical annuloplasty have been explored but are not routine clinical practice . It remains unclear whether patients with FMR with dilated annulus can benefit from ringless MitraClip® repair.…”

“…Percutaneous approaches to mimic surgical annuloplasty have been explored but are not routine clinical practice. 8,9 It remains unclear whether patients with FMR with dilated annulus can benefit from ringless MitraClip 1 repair. The aim of our study was to characterize the impact of MitraClip 1 implantation on mitral annular geometry and valve function in patients with DMR, FMR, and mixed mitral regurgitation (MMR).…”

Hospital-based health technology assessment on the use of mitral clips in the treatment of mitral regurgitation

“…Specifically Tables 1 and 2 [1][2][3][4][5][6][22][23][24][25][26]. It is important to underline that in reality not all of the criteria are necessary for a correct application of the mitral clip, but there are parameters that are essential (necessary), others which are assessed by the surgical team (important), and those of little relevance (NO).…”

Simulation Based Design and Evaluation of a Transcatheter Mitral Heart Valve Frame

“…Of concern though is the varying coronary sinus location/motion and the reshaping of the mitral valve remains. Other direct annuloplasty techniques such as the AccuCinch™ System (Guided Delivery Systems, Inc., Santa Clara, CA) require a larger access site, which could lead to more surgical complications or longer patient recovery times [7]. Further percutaneous mechanical concepts have been explored to treat mitral valve regurgitation such as clips or even stitching the mitral valve leaflet together, essentially forming a double orifice.…”