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Post-script. Percutaneous mitral valve repair using the MitraClip® device (e-valve). Angela Hoye , Rajesh Nair, Farqad Alamgir Castle Hill Hospital, Hull. No conflict of interest in relation to this presentation. Mitral regurgitation occurs due to: valvular degeneration (50%)

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percutaneous mitral valve repair using the mitraclip device e valve

Post-script

Percutaneous mitral valve repair using the MitraClip® device (e-valve)
  • Angela Hoye,Rajesh Nair, Farqad Alamgir
  • Castle Hill Hospital, Hull
introduction mr
Mitral regurgitation occurs due to:

valvular degeneration (50%)

rheumatic disease (20%)

ischaemia (17%)

Where possible, surgical mortality is lower following MV repair rather than replacement

However, after MV repair surgery, published data show a rate of recurrence of grade 3 or 4 MR of 17-20% at 5 yrs

Introduction: MR
the alfieri technique
The surgical “edge-to-edge” technique was first described in early 1990`s (Alfieri)

Over 1,500 pts reported in the literature

Safe, effective, durable

No occurrence of mitral stenosis

Facilitates proper leaflet coaptation

Degenerative - anchor flail / prolapsing leaflets

Functional - Coapt tethered leaflets to reduce time and force required to close valve

Creates tissue bridge

The Alfieri technique
the alfieri technique6
The Alfieri technique
  • Euro Heart Survey demonstrated that despite presence of severe MR and symptoms, HALF of all patients are not considered for surgery
  • CE Mark approval in March 2008
anatomic suitability leaflet mal coaptation resulting in mr
Sufficient leaflet tissue for mechanical coaptation

Non-rheumatic/endocarditic valve morphology

Anatomic considerations

Flail gap <10mm

Flail width <15mm

Mitral Area > 4.0cm

Coaptation length > 2mm

>2mm

>11mm

<10mm

<15mm

Anatomic SuitabilityLeaflet mal-coaptation resulting in MR
studies
Studies
  • 47 sites
data everest
Age 18 years or older

Moderate to severe (3+) or severe (4+) MR

Symptomatic

Asymptomatic with LVEF < 60% or LVESD > 40mm*

MR originates from A2-P2 mal-coaptation

Candidate for mitral valve surgery

Key exclusions:

EF < 25% or LVESD > 55 mm

Renal insufficiency

Endocarditis, rheumatic heart disease

Data: EVEREST

*ACC/AHA Guidelines, Circ. 114;450,2006

results
EVEREST I + roll-in phase of EVEREST IIResults

One or more Clips implanted in 90% of cases

clinical results
Clinical results

99%

97%

Survival

96%

96%

96%

92%

89%

Freedom from surgery

86%

85%

82%

84%

75%

67%

66%

65%

63%

Freedom from death, surgery & MR > 2+

our experience
All potential patients were discussed at MDT

Pre-procedural TTE and TOE to determine suitability

Teamwork is vital

Interventional cardiologist

Cardiac anaesthetist

ECHO specialist

Lab staff – specialist training given to nursing staff

All procedures performed with support from physicians from the company

Our experience
our experience15
Successfully treated 3 patients, all with degenerative MR

2 pts with a single clip, 1 with 2 clips

No procedural MACE

At 1 month, all patients report a marked improvement in symptoms / exercise capacity

Our experience
slide18

Amplatz

Guide

conclusions
Preliminary results of percutaneous mitral valve repair with the MitraClip® demonstrate that it is safe and feasible

Steep learning curve and it is essential to understand MV anatomy and TOE images

Definite place for this technology in a subset of patients with MR and suitable anatomy

All potential candidates should be evaluated by a multidisciplinary team

Patient selection is paramount

Conclusions