The MitraClip Device and Procedural Overview

11.1

Key Points

• Percutaneous transcatheter therapies for mitral regurgitation (MR) have found a role for patients at high operative risk with both degenerative and functional pathologies.

• The MitraClip (Abbott Vascular Structural Heart, Menlo Park, Calif.) therapy utilizes a catheter-based system to deliver a clip-type implant to provide apposition between anterior and posterior mitral leaflets.

• Careful patient selection with a thoughtful eye to appropriate mitral pathology remains paramount for success with the MitraClip.

• Technical success is dependent on skill with echocardiographic imaging, with three-dimensional transesophageal echocardiography (TEE) being particularly valuable.

11.2

Background

MR from nonrheumatic etiology may be the result of either degenerative valve disease, such as prolapse, chordal rupture, or myxomatous degeneration, or of functional etiologies such as ischemic cardiomyopathy and secondary MR. Additionally, as surgical or transcatheter therapies focus on functional etiologies of MR, the knowledge base of how the disease of the ventricle affects the mitral apparatus will increase. Significant MR (3+ or 4+) occurs in 0.5% of the population, with approximately 250,000 new cases annually in the United States. For patients with significant organic MR, medical therapy has been shown to be ineffective in treating the underlying pathophysiology and is unable to retard disease progression. Surgical repair or replacement is the standard of care, because it is efficacious and low risk. However, it has been estimated that only about 20% of patients with significant MR undergo surgery. Therefore there is a significant unmet therapeutic need for patients with mitral valve regurgitation, and particularly for patients at high surgical risk, a significant opportunity for novel catheter-based therapies.

11.3

Adapted from a Surgical Approach to Mitral Regurgitation

Currently, surgery for MR has become a mature therapy, with a wide range of different techniques involving leaflet, chordal, and annular approaches. Concepts behind each of these approaches have been used by novel transcatheter approaches to repair of MR. Additionally, work continues to create a transcatheter replacement option for mitral valve disease.