Percutaneous Treatment of Mitral Regurgitation: The MitraClip Experience
Section snippets
MitraClip system: historical perspective
In 1992, Otavio Alfieri and colleagues2 described a technique where the mitral leaflet mal-coaptation was corrected by placing a surgical suture to approximate the mid portion of the anterior and posterior leaflets. This “edge-to-edge” technique is usually applied to the A2-P2 central segment of the leaflets, creating a double orifice and reducing MR. Results up to 12 years in patients treated with surgical edge-to-edge repair have been reported.3
Alfieri and colleagues’ approach for mitral
The EVEREST Trials
Outcomes of therapy with the MitraClip device have been evaluated in the United States in the EVEREST registry, EVEREST II Randomized Trial, and EVEREST II High-Risk Registry. Patients continue to be enrolled in REALISM, the continued access registry of EVEREST II. The total number of patients enrolled in these trials exceeds 1000, rendering the MitraClip the most well investigated percutaneous device for treatment of MR.
Limitations of the MitraClip device
Despite its obvious potential, there are several recognized limitations to the MitraClip therapy. The device requires introduction of a 24-Fr guide catheter to the femoral vein, which has potential to cause vascular damage and injury of the intra-atrial septum. Despite this, blood transfusions continued to be far more prevalent in the surgical arm of the randomized trial. The septum seems to heal in the vast majority of patients and atrial septal defect has not been a significant problem in the
Summary
In the randomized EVEREST II trial, 80% of patients were free of need for surgery 1 year after MitraClip therapy. Although percutaneous repair was less effective at reducing MR than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes. The US EVEREST trial experience, in combination with the commercial use of the MitraClip device in Europe, has enabled more than 3000 patients to benefit from this novel therapy. It is clear that
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Disclosures: Dr Feldman is a consult for and receives research grants from Abbott, Boston Scientific, and Edwards. Dr Perlowski has nothing to disclose.