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Treatment of severe mitral regurgitation with MitraClip system — a single-centre study
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Abstract
Introduction. MitraClip (MC) is a catheter-based device to treat mitral regurgitation (MR). This method uses a transseptal approach and is based on the creation of a double orifice mitral valve by suturing of the middle scallops of the mitral valve’s leaflets.
Aim. The aim of the study was to assess the effectiveness of MC method in treating patients with severe MR. We analysed MR severity, patient’s clinical condition evaluated by New York Heart Association (NYHA) functional class, and the function of the left ventricle evaluated by Left Ventricle Ejection Fraction (LVEF).
Methods. A retrospective single-centre study with patients hospitalised at the Department of Cardiology and Internal Medicine in Bydgoszcz. All diagnosed with severe MR and treated by performing MC procedure in the time period from August 2010 to December 2014. The following data from medical history (NYHA class) and echocardiography examinations (MR severity and LVEF) were analysed in three time points: before, right after the procedure, and after the follow-up period (four weeks since discharge).
Results. The studied group consisted of 11 patients — 8 male, 3 female, aged 64.4 ( ± 10.2) years, treated with MC. All of the three analysed parameters improved relevantly as a result of the evaluated procedure. The percentage of patients classified as NYHA class III/IV presents as follows: 90% before the procedure, 55% after MC implantation (ns), and 44% after the follow-up period (p = 0.01). All patients suffered from severe-to-moderate (3+) and severe (4+) MR before the procedure. After implantation only 9% (ns) were still classified with 3+/4+ MR, and after the follow-up this percentage reached 18% (p = 0.0005). We observed relevant changes of LVEF. The average LVEF at baseline was 27.9 ± 2%, which increased to 29.6 ± 2% (ns) after the MC implantation and 34 ± 7% (p = 0.02) after the follow-up.
Conclusion. MC therapy is effective in patients with severe symptomatic MR with congestive heart failure and decreased LVEF. It reduces MR severity both acutely and after the follow-up period and improves NYHA class and LVEF.
Abstract
Introduction. MitraClip (MC) is a catheter-based device to treat mitral regurgitation (MR). This method uses a transseptal approach and is based on the creation of a double orifice mitral valve by suturing of the middle scallops of the mitral valve’s leaflets.
Aim. The aim of the study was to assess the effectiveness of MC method in treating patients with severe MR. We analysed MR severity, patient’s clinical condition evaluated by New York Heart Association (NYHA) functional class, and the function of the left ventricle evaluated by Left Ventricle Ejection Fraction (LVEF).
Methods. A retrospective single-centre study with patients hospitalised at the Department of Cardiology and Internal Medicine in Bydgoszcz. All diagnosed with severe MR and treated by performing MC procedure in the time period from August 2010 to December 2014. The following data from medical history (NYHA class) and echocardiography examinations (MR severity and LVEF) were analysed in three time points: before, right after the procedure, and after the follow-up period (four weeks since discharge).
Results. The studied group consisted of 11 patients — 8 male, 3 female, aged 64.4 ( ± 10.2) years, treated with MC. All of the three analysed parameters improved relevantly as a result of the evaluated procedure. The percentage of patients classified as NYHA class III/IV presents as follows: 90% before the procedure, 55% after MC implantation (ns), and 44% after the follow-up period (p = 0.01). All patients suffered from severe-to-moderate (3+) and severe (4+) MR before the procedure. After implantation only 9% (ns) were still classified with 3+/4+ MR, and after the follow-up this percentage reached 18% (p = 0.0005). We observed relevant changes of LVEF. The average LVEF at baseline was 27.9 ± 2%, which increased to 29.6 ± 2% (ns) after the MC implantation and 34 ± 7% (p = 0.02) after the follow-up.
Conclusion. MC therapy is effective in patients with severe symptomatic MR with congestive heart failure and decreased LVEF. It reduces MR severity both acutely and after the follow-up period and improves NYHA class and LVEF.
Keywords
mitral regurgitation, MitraClip
About this articleTitle
Treatment of severe mitral regurgitation with MitraClip system — a single-centre study
Journal
Issue
Article type
Original article
Pages
81-87
Published online
2016-12-02
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6501
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947
DOI
Bibliographic record
Medical Research Journal 2016;1(2):81-87.
Keywords
mitral regurgitation
MitraClip
Authors
Jakub Ratajczak
Ewa Jaworska
Maria Tomczak
Emilia Kolasińska
Paulina Badziągowska
Jan Kłopocki
Iwona Świątkiewicz
Adam Sukiennik
References (16)- Munkholm-Larsen S, Wan B, Tian DH, et al. A systematic review on the safety and efficacy of percutaneous edge-to-edge mitral valve repair with the MitraClip system for high surgical risk candidates. Heart. 2014; 100(6): 473–478.
- Kübler P, Kustrzycka-Kratochwil D, Telichowski A, et al. Percutaneous reduction of mitral valve regurgitation using the MitraClip system - immediate and 90-day follow-up of 3 cases. Postepy Kardiol Interwencyjnej. 2013; 9(2): 126–131.
- Yeo KK, Ding ZP, Chua YL, et al. Percutaneous mitral valve repair with MitraClip for severe functional mitral regurgitation. Singapore Med J. 2013; 54(1): e9–e12.
- Feldman T, Kar S, Elmariah S, et al. EVEREST II Investigators, EVEREST Investigators, EVEREST II Investigators, EVEREST II Investigators, EVEREST Investigators. Beating heart catheter-based edge-to-edge mitral valve procedure in a porcine model: efficacy and healing response. Circulation. 2004; 110(8): 988–993.
- Pregowski J, Witkowski A. Percutaneous treatment of mitral regurgitation with MitraClip device. Postepy Kardiol Interwencyjnej. 2013; 9(4): 383–389.
- Świątkiewicz I, Rychter M. Nowe techniki w kardiologii: rola echokardiografii w kwalifikacji i monitorowaniu przezskórnej implantacji systemu MitraClip w leczeniu niedomykalności mitralnej. Kardiol Dyp. 2011; 10: 43–53.
- Ratajczak J, Sukiennik A, Sielski S, et al. Successful reduction of severe mitral regurgitation after implantation of four MitraClip devices. Medical Research Journal. 2016; 3(4): 176–179.
- Kalarus Z, Kukulski T, Lekston A, et al. Metodyka i bezpieczeństwo zabiegu przeznaczyniowej redukcji ciężkiej pozawałowej niedomykalności mitralnej metodą MitraClip u 3 chorych wysokiego ryzyka leczenia operacyjnego — pierwsze polskie doświadczenia. Kardiol Pol. 2010; 6: 729–735.
- Franzen O, van der Heyden J, Baldus S, et al. MitraClip® therapy in patients with end-stage systolic heart failure. Eur J Heart Fail. 2011; 13(5): 569–576.
- Baldus S, Schillinger W, Franzen O, et al. German Transcatheter Mitral Valve Interventions (TRAMI) investigators. MitraClip therapy in daily clinical practice: initial results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail. 2012; 14(9): 1050–1055.
- Gaemperli O, Biaggi P, Gugelmann R, et al. Real-time left ventricular pressure-volume loops during percutaneous mitral valve repair with the MitraClip system. Circulation. 2013; 127(9): 1018–1027.
- Armoiry X, Brochet E, Lefevre T, et al. Initial French experience of percutaneous mitral valve repair with the MitraClip: a multicentre national registry. Arch Cardiovasc Dis. 2013; 106(5): 287–294.
- Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol. 2013; 62(12): 1052–1061.
- Koifman E, Fefer P, Hay I, et al. MitraClip implantation for high risk patients with severe mitral regurgitation: the Sheba experience. Isr Med Assoc J. 2014; 16(2): 91–95.
- Toggweiler S, Zuber M, Sürder D, et al. Two-year outcomes after percutaneous mitral valve repair with the MitraClip system: durability of the procedure and predictors of outcome. Open Heart. 2014; 1(1): e000056.
- Feldman T, Kar S, Rinaldi M, et al. EVEREST Investigators. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol. 2009; 54(8): 686–694.