MitraClip: a novel percutaneous approach to mitral valve repair

Abstract

As life expectancy increases, valvular heart disease is becoming more common. Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population. Recent years have brought a progression of surgical treatments toward less invasive strategies. This has given rise to percutaneous approaches for the correction of valvular heart disease. Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation. We review the rationale, procedural aspects, and clinical data thus far available for the MitraClip approach to mitral regurgitation.

Figures

Fig. 1

Evalve MitraClip system (a) and MitraClip device (b) The system consists of two principal components: (i) a clip delivery system (CDS) used to position and deploy the clip and (ii) a steerable guide catheter. The MitraClip device (iii) is attached to the CDS. A stabilizer keeps the system precisely in position

Fig. 2

Anatomical inclusion criteria for the MitraClip device Failure to meet any of these is an important exclusion. (a) Four-chamber view: flail gap is shown and should be

Fig. 3

MitraClip procedure with two- and three-dimensional TEE guidance (a, b) Two-dimensional TEE (long axis/three-chamber view). (a) Positioning clip; (b) Deployed clip with leaflets grasped; (c, d) Three-dimensional TEE (3D en face view). (c) Correctly orientating the clip in the 3D en face view; (d) Deployed clip with creation of the double orifice