Percutaneous approach for treating mitral regurgitation with mitral clip (MitraClip)

Czech version

Authors: Michael Želízko; Vladimír Pořízka; Radka Kočková
Authors‘ workplace: Klinika kardiologie IKEM Praha, přednosta prof. MUDr. Josef Kautzner, CSc.
Published in: Vnitř Lék 2014; 60(12): 1090-1094
Category: 70. birthday prof. MUDr. Michael Aschermann, DrSc., FESC, FACC

Overview

Mitral regurgitation (MR) is the second most commonly encountered valvular lesion and it has been positively correlated with the subsequent development of heart failure and death. MitraClip therapy is a new percutaneous approach for treating mitral regurgitation which involves mechanical edge-to-edge coaptation of the mitral leaflets that is analogous to the surgical Alfieri technique. Indication for MitraClip in patients with severe degenerative or functional mitral regurgitation is based on clinical symptoms (NYHA II-IV) and specific anatomic criteria including a primary central regurgitant jet associated with the A2/P2 segments, in functional MR a coaptation length ≥ 2 mm, a coaptation depth ≤ 11 mm, in degenerative MR a flail gap <10 mm, and a flail width < 15 mm. Key exclusion criteria included LVEF ≤ 25%, LV end-systolic dimension > 55 mm, mitral valve orifice area < 4 cm², recent myocardial infarction or endocarditis. The safety profile of the procedure appears to be excellent. Acute outcomes are favourable, and mid-term durability (up to 2years) is reasonable. Patients who are older, at higher risk for surgical therapy, or with functional mitral regurgitation (FMR) and depressed ejection fractions will constitute the initial target population for MitraClip therapy. Since FMR is primarily a ventricular problem, it remains to be seen whether a leaflet intervention will have durable efficacy.

Key words:
indication criteria – mitral regurgitation – mitral clip (MitraClip) – exclusion criteria

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