A minimally invasive procedure to repair severe mitral valve regurgitation by clipping together the valve’s leaflets can improve function and quality of life and reduce the risk of hospitalisation, research shows. Approximately a third of patients who have the procedure need more than one clip to correct the problem, suggest data being presented at the 27th annual International Symposium on Endovascular Therapy (ISET).
Recently approved by the Food and Drug Administration, the MitraClip holds together the mitral valve’s leaflets to reduce the degree of regurgitation caused by mitral valve regurgitation.
“In many cases one clip is sufficient. However, in one-third of the patients additional clips are necessary to reduce the degree of regurgitation without producing stenosis, making the valve too tight,” said Ramon Quesada, medical director of interventional cardiology and cardiac research for the Miami Cardiovascular Institute. “That is good news, especially for people with no other options.”
Quesada was an investigator in the EVEREST II trial, which enrolled 279 patients with severe mitral valve disease. Patients were randomised to either undergo surgical repair (95 patients) or to have the clip placed (184 patients). In the subgroup of patients who were at high risk for surgical repair it was found that the Mitraclip procedure was beneficial because it improved the patient’s cardiovascular function and reduced the rate of hospitalisation for heart failure.
Mitral valve regurgitation is the most common type of heart valve problem in the USA. Every year, about 50,000 people have a severe enough problem that they require surgery, the gold standard treatment. However, open-heart surgical valve repair is a major procedure requiring heart-lung bypass and prolonged anaesthesia. Because many of these patients are older, surgery is often considered too high risk. In the non-surgical transcatheter treatment with MitraClip, the physician threads a catheter through the arteries and advances a clothespin-like clip into the heart’s left atrium where it is positioned to clasp the leaflets together, allowing blood to continue flowing but not back up into the atrium. The device is made of metal and covered with a polyester fabric.
