Transcatheter mitral valve repair
- Ehrin J Armstrong, MD, MSc, FACC
Ehrin J Armstrong, MD, MSc, FACC
- Associate Professor Medicine
- University of Colorado School of Medicine
- Elyse Foster, MD
Elyse Foster, MD
- Professor of Clinical Medicine
- University of California, San Francisco
Transcatheter mitral valve repair (TMVR) is a minimally invasive technique for treatment of symptomatic chronic moderate-severe or severe mitral regurgitation (MR). While a number of technologies are in clinical development, an edge-to-edge leaflet repair device (the MitraClip) is currently the only United States Food and Drug Administration-approved device for TMVR. The MitraClip, as well as the CARILLON mitral annuloplasty device, have CE Mark approval.
This article reviews TMVR, with a focus on the indications for treatment, patient selection, outcomes, and complications using the MitraClip device.
An overview of management of chronic MR and surgical treatment of chronic MR are presented elsewhere. (See "Management of chronic primary mitral regurgitation" and "Surgical procedures for severe chronic mitral regurgitation".)
Mitral regurgitation (MR) can be caused by a primary disease of the valve leaflets (so-called primary MR, which is most commonly caused by “degenerative” or myxomatous mitral valve disease in developed countries), or by secondary (functional) causes such as by adverse left ventricular remodeling from cardiomyopathy or coronary artery disease. (See "Pathophysiology of chronic mitral regurgitation" and "Clinical manifestations and diagnosis of chronic mitral regurgitation".)
TRANSCATHETER LEAFLET REPAIR TECHNOLOGY
The MitraClip is a transcatheter technology based on the surgical Alfieri edge-to-edge repair, which involves suturing the regurgitant orifice of the mitral valve leaflets together, thereby creating a “double orifice” mitral valve . The MitraClip system utilizes a cobalt chromium clip covered with a polypropylene fabric that grasps both the anterior and posterior mitral valve leaflets, thereby reducing mitral regurgitation (MR) by increasing the coaptation between the regurgitant valve leaflets. In some cases, a second clip may be required to adequately reduce the MR severity toward a goal of final regurgitant severity ≤2+ . Although the MitraClip has been used to treat both primary and secondary MR, it is currently United States Food and Drug Administration-approved for commercial use only in patients with 3 to 4+ primary (degenerative) MR.
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- TRANSCATHETER LEAFLET REPAIR TECHNOLOGY
- CANDIDATES FOR TRANSCATHETER MITRAL VALVE REPAIR
- Echocardiographic criteria
- Determination of surgical risk
- OUTCOMES OF TRANSCATHETER MITRAL VALVE REPAIR
- Early results
- Comparison with surgical mitral valve repair
- Reduction in mitral regurgitation
- Left ventricular reverse remodeling
- Functional and quality of life improvement
- Use for secondary MR
- COMPLICATIONS OF TRANSCATHETER MITRAL VALVE REPAIR
- Device embolization or partial clip detachment
- Mitral stenosis
- Infective endocarditis
- INVESTIGATIONAL TECHNOLOGIES
- SUMMARY AND RECOMMENDATIONS