Predicting device failure after percutaneous repair of functional mitral regurgitation in advanced heart failure: Implications for patient selection

Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two‐ and three‐dimensional echocardiography

“…More broadly, all analyses performed in this study are consistent with methods applied and validated by our group and others in prior large epidemiologic and outcomes research . Second, whereas our sample size ( n = 67) was similar to several other studies that have tested imaging predictors of MClp response ( n = 50–77), larger multicenter prospective studies are warranted to confirm our findings and test LV remodeling as a predictor of post‐MClp clinical outcomes. On the other hand, prior studies examining MClp response have linked recurrent or residual MR to prognosis, and shown mortality to parallel MR severity .…”

“…Our finding of increased inter‐papillary diameter among MR patients with sub‐optimal MClp results supports the notion that systemic changes in LV geometry influence procedural success. In another study, Stolfo et al reported LV size to be a predictor of device failure, but the cohort was limited to patients with functional MR and advanced heart failure (LVEF < 40%) . Of note, the cohort studied by Stolfo et al did not include patients with degenerative MR—the population in whom MClp is currently commercially approved in the United States and that mechanisms for MClp response in patients with functional MR cannot necessarily be extrapolated to other causalities of MR, providing a logical rationale for our study.…”

“…In another study, Stolfo et al reported LV size to be a predictor of device failure, but the cohort was limited to patients with functional MR and advanced heart failure (LVEF < 40%). 25 Of note, the cohort studied by It is important to recognize that our study assessed MClp response using a cutoff of ≤mild (1+) MR, to test LV remodeling in relation to procedural success. The approach is consistent with that employed in several prior studies, and supported by data showing MClp patients with greater residual MR (≥2+) to have worse clinical prognosis.…”

Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve repair

“…Surgical repair of MR can be accomplished with direct suturing of the cleft, or on occasion with an Alfieri‐type repair . Leaflet morphology, valve pathology, and annular dimensions are some of many variables that impact procedural success with percutaneous repair using the MitraClip device, and while achieving mild residual MR in patients with cleft leaflets may seem unattainable, we demonstrate two cases of successful repair. In the first case, the cleft was in the very medial aspect of the middle scallop which resulted in a small residual jet, while in the second case, the cleft was in the middle of the anterior leaflet, but side‐by‐side clips around the cleft allowed for isolation of the jet in between the clips.…”

Galectin‐3 and ST2 as predictors of therapeutic success in high‐risk patients undergoing percutaneous mitral valve repair (MitraClip)

“…Moreover, Stolfo et al described important morphological and anatomical aspects that have influenced procedural success or device failure. 7 In this study, reduced left ventricular (LV) function, anatomical aspects (such as anteroposterior diameter of the mitral annulus), and LV end-diastolic volume influenced the technical success of PMVR using the MitraClip System. 7,8 To date, however, there is no evidence of the impact of cardiac fibrotic burden on the success of MR reduction after PMVR using the MitraClip system, although the procedure is known to be technically successful.…”