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-Current indications and contraindications to the edge-to-edge technique. Indications Contraindications
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Percutaneous repair of the mitral valve has been widely adopted for the treatment of primary, symptomatic severe mitral regurgitation in patients at prohibitive risk for surgical intervention. We present a case of an elderly female patient with moderate-to-severe mitral regurgitation who underwent MitraClip procedure, with postprocedural course rem...
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Citations
... Te edge-to-edge technique was primarily utilized in Group 2, as opposed to Group 1 (10.2% vs. 2.4%) due to the higher complexity scores from Anyanwu's system seen in Group 2, indicating the need for multiple repair techniques for successful MV repair. Te technique was employed as a backup solution in cases where repair proved inadequate [24]. Its straightforwardness and efciency, particularly in challenging circumstances such as those observed in Group 2, have made it a preferred choice. ...
Purpose. Minimally invasive mitral valve repair (MIMVR) has been demonstrated to be safe and effective, but technical difficulty, outcome variation, and lack of standardized protocols undermine the utility of artificial chordae. This study aims to analyze the midterm outcomes of repair using artificial chordae through right minithoracotomy. Methods. A retrospective cohort study was conducted on consecutive patients who underwent MIMVR using artificial chordae at a single center in Vietnam between April 2016 and April 2022. Valve repairs were separated into two groups based on a previously validated complexity score: simple repair (Group 1) and intermediate-to-complex repair (Group 2). Demographic variables, comorbidities, operative characteristics, surgical outcomes, and follow-up data on survival and mitral regurgitation (MR) grade were analyzed. The learning curve was assessed by comparing the number of procedures with operation time and aorta cross-clamp time. Primary endpoints included survival and freedom from recurrent MR at four years. Results. Ninety patients were identified, including 41 simple and 49 intermediate-to-complex repairs. The mean age was 50.5 ± 12.9 years. Both groups had similar preoperative characteristics. The perioperative and postoperative outcomes were favorable, with no cases requiring mitral valve replacement. The median follow-up time was 30.3 months (18.2–40.4), and there were two (2.2%) cardiac deaths, with one in each group. The Kaplan–Meier survival estimates for Groups 1 and 2 at 12 and 24 months were 97% vs. 100% and 97% vs. 96%, respectively (95% CI = 0.05–12.2, P = 0.850 ), and estimates for freedom from recurrent MR were 97% vs. 92% and 97% vs. 88%, respectively (95% CI = 0.49–12.0, P = 0.260 ). There was a negative association between the volume of operations and the duration of operation and aortic cross-clamp time, leading to shorter durations. Conclusion. Based on our single-center experience, MIMVR using artificial chordae via right mini-thoracotomy can be safely and effectively performed in resource-limited countries for patients with MR. This approach has been shown to be applicable for a range of MR complexities, from simple to intermediate-to-complex MV repairs, and has demonstrated promising results in terms of midterm freedom from MR recurrence.
... Advances in procedural tools in MitraClip procedure allow safety and versatility First described by Alfieri et al. 1 in 1995, E2E technique has demonstrated its efficacy and durability in treatment of different anatomical complex settings and functional conditions and even in more compromised patients thanks to short cardiopulmonary run period. [2][3][4] The MitraClip system (Abbott Vascular, Santa Clara, CA, USA) is the catheter-based mitral valve repair (MVP) 5 method inspired by the surgical E2E technique. Patient selection for MitraClip procedure is provided by echocardiographic characteristics obtained by twodimensional (2D) transthoracic echocardiography (TTE) and/or transoesophageal echocardiography (TOE) in order to define the mechanism of MR and to evaluate the anatomic suitability for a MitraClip implantation. ...
Improvements in procedural technique and intra-procedural imaging have progressively expanded the indications of percutaneous edge-to-edge technique. To date in higher volume centres and by experienced operators MitraClip is used for the treatment of complex anatomies and challenging cases in high risk-inoperable patients. This progressive step is superimposable to what observed in surgery for edge-to-edge surgery (Alfieri's technique). Moreover, the results of clinical studies on the treatment of patients with high surgical risk and functional mitral insufficiency have confirmed that the main goal to be achieved for improving clinical outcomes of patients with severe mitral regurgitation (MR) is the reduction of MR itself. The MitraClip should therefore be considered as a tool to achieve this goal in addition to medical therapy. Nowadays, evaluation of patient's candidacy to MitraClip procedure, discussed in local Heart Team, must take into account not only the clinical features of patients but even the experience of the operators and the volume of the centre, which are mostly related to the probability to achieve good procedural results. This 'relative feasibility' of challenges cases by experienced operators should always been taken into account in selecting patients for MitraClip. Here, we present a review of the literature available on the treatment of complex and challenging lesions.
