Percutaneous and surgical treatment of mitral valve regurgitation

Abstract

Background: Mitral valve regurgitation is the second most common clinically relevant valvular heart disease in adults, with an incidence of about 2% to 3% per year. Surgical mitral valve repair is the treatment of choice. Recent years have seen major advances in minimally invasive mitral valve surgery. Several new catheter-based techniques are now being clinically evaluated, including percutaneous endovascular mitral valve repair with a mitral clip.

Method: This review is based on a selective review of the literature and on the authors' clinical experience.

Results: Minimally invasive and reconstructive techniques for mitral valve surgery have come into more common use in recent years. In Germany, more than 50% of all mitral valve defects are now treated with a valve-preserving repair procedure. At the same time, percutaneous techniques have been developed that enable reduction of mitral regurgitation in the cardiac catheterization laboratory, without surgery. The implantation of a mitral clip is the sole currently approved technique of this type. In a recently published, randomized comparative clinical trial (EVEREST II), it was found to be safer, but less effective, than surgery.

Conclusion: Mitral valve surgery remains the treatment of choice for severe mitral regurgitation. For patients at high risk from surgery, and particularly those with severe heart failure, the implantation of a mitral clip is a safe and feasible treatment option.

Figures

Figure 1

Intraoperative setup for the minimally invasive mitral valve operation with right lateral minithoracotomy (upper) and femoral catheterization (middle) for extracorporeal circulation; cosmetic result (lower)

Figure 2

Mitral clip implantation: transesophageal echocardiography visualizes capture and fixation of the mitral leaflets. Upper left: the open clip is seen in the left ventricle. Upper right: the open clip is pulled back towards the mitral leaflets. Lower left: having grasped the leaflets, the clip is closed. Lower right: schematic representation of endovascular mitral valve reconstruction (view of the mitral valve from the left atrium). LA, left atrium; LV, left ventricle; AV, aortic valve; arrow, clip arm