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Transcatheter mitral valve repair

Authors
Ehrin J Armstrong, MD, MSc, FACC
Elyse Foster, MD
Section Editor
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

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".)

PATHOPHYSIOLOGY

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 [1]. 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+ [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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Literature review current through: Nov 2016. | This topic last updated: Fri Oct 07 00:00:00 GMT+00:00 2016.
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