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Review article: Biomedical intelligence

Vol. 149 No. 0910 (2019)

Interventional treatment of mitral valve regurgitation: an alternative to surgery?

DOI
https://doi.org/10.4414/smw.2019.20023
Cite this as:
Swiss Med Wkly. 2019;149:w20023
Published
10.03.2019

Abstract

Mitral regurgitation (MR) is a highly prevalent condition among elderly patients, affecting almost 10% of the general population aged 75 and older. Left untreated, severe MR results in high mortality and frequent hospitalisation for treatment of heart failure. Surgical treatment remains the first-line therapy for symptomatic, severe MR, especially for patients presenting with a primary aetiology. However, a high proportion of patients with MR are turned down for open-heart surgery, mainly due to advanced age, diminished left ventricular function and comorbidities. Thus, percutaneous treatment options have been recently developed as an alternative. In this article, we will review transcatheter interventional techniques at the level of the mitral valve, including implantation technique, indications and clinical results.

References

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11. doi:.https://doi.org/10.1016/S0140-6736(06)69208-8
  2. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373(9672):1382–94. doi:.https://doi.org/10.1016/S0140-6736(09)60692-9
  3. Goel SS, Bajaj N, Aggarwal B, Gupta S, Poddar KL, Ige M, et al. Prevalence and outcomes of unoperated patients with severe symptomatic mitral regurgitation and heart failure: comprehensive analysis to determine the potential role of MitraClip for this unmet need. J Am Coll Cardiol. 2014;63(2):185–6. doi:.https://doi.org/10.1016/j.jacc.2013.08.723
  4. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al.; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91. doi:.https://doi.org/10.1093/eurheartj/ehx391
  5. David TE, Armstrong S, McCrindle BW, Manlhiot C. Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease. Circulation. 2013;127(14):1485–92. doi:.https://doi.org/10.1161/CIRCULATIONAHA.112.000699
  6. Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995;91(4):1022–8. doi:.https://doi.org/10.1161/01.CIR.91.4.1022
  7. Samad Z, Shaw LK, Phelan M, Ersboll M, Risum N, Al-Khalidi HR, et al. Management and outcomes in patients with moderate or severe functional mitral regurgitation and severe left ventricular dysfunction. Eur Heart J. 2015;36(40):2733–41. doi:.https://doi.org/10.1093/eurheartj/ehv343
  8. [REMOVED IF= FIELD]8 Acker MA, Bolling S, Shemin R, Kirklin J, Oh JK, Mann DL, et al. Mitral valve surgery in heart failure: insights from the Acorn Clinical Trial. J Thorac Cardiovasc Surg. 2006;132(3):568-77, 77 e1-4.
  9. Serri K, Bouchard D, Demers P, Coutu M, Pellerin M, Carrier M, et al. Is a good perioperative echocardiographic result predictive of durability in ischemic mitral valve repair? J Thorac Cardiovasc Surg. 2006;131(3):565-73 e2.
  10. McGee EC, Jr, Gillinov AM, Blackstone EH, Rajeswaran J, Cohen G, Najam F, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004;128(6):916–24. doi:.https://doi.org/10.1016/j.jtcvs.2004.07.037
  11. Magne J, Sénéchal M, Dumesnil JG, Pibarot P. Ischemic mitral regurgitation: a complex multifaceted disease. Cardiology. 2009;112(4):244–59. doi:.https://doi.org/10.1159/000151693
  12. Goldstein D, Moskowitz AJ, Gelijns AC, Ailawadi G, Parides MK, Perrault LP, et al.; CTSN. Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation. N Engl J Med. 2016;374(4):344–53. doi:.https://doi.org/10.1056/NEJMoa1512913
  13. Mirabel M, Iung B, Baron G, Messika-Zeitoun D, Détaint D, Vanoverschelde JL, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358–65. doi:.https://doi.org/10.1093/eurheartj/ehm001
  14. Andalib A, Mamane S, Schiller I, Zakem A, Mylotte D, Martucci G, et al. A systematic review and meta-analysis of surgical outcomes following mitral valve surgery in octogenarians: implications for transcatheter mitral valve interventions. EuroIntervention. 2014;9(10):1225-34.
  15. Andalib A, Chetrit M, Eberg M, Filion KB, Thériault-Lauzier P, Lange R, et al. A Systematic Review and Meta-Analysis of Outcomes Following Mitral Valve Surgery in Patients with Significant Functional Mitral Regurgitation and Left Ventricular Dysfunction. J Heart Valve Dis. 2016;25(6):696–707.
  16. Maisano F, Caldarola A, Blasio A, De Bonis M, La Canna G, Alfieri O. Midterm results of edge-to-edge mitral valve repair without annuloplasty. J Thorac Cardiovasc Surg. 2003;126(6):1987–97. doi:.https://doi.org/10.1016/S0022-5223(03)01291-1
  17. Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, et al.; STS/ACC TVT Registry. 2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Coll Cardiol. 2017;69(10):1215–30. doi:.https://doi.org/10.1016/j.jacc.2016.11.033
  18. Praz F, Spargias K, Chrissoheris M, Büllesfeld L, Nickenig G, Deuschl F, et al. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study. Lancet. 2017;390(10096):773–80. doi:.https://doi.org/10.1016/S0140-6736(17)31600-8
  19. Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, et al.; MITRA-FR Investigators. Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. N Engl J Med. 2018;379(24):2297–306. doi:.https://doi.org/10.1056/NEJMoa1805374
  20. Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al.; COAPT Investigators. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018;379(24):2307–18. doi:.https://doi.org/10.1056/NEJMoa1806640
  21. Messika-Zeitoun D, Nickenig G, Latib A, Kuck KH, Baldus S, Schueler R, et al. Transcatheter mitral valve repair for functional mitral regurgitation using the Cardioband system: 1 year outcomes. Eur Heart J. 2019;40(5):466–72. doi:.https://doi.org/10.1093/eurheartj/ehy424
  22. Ristalli F, Meucci F, Stolcova M, Valente S, Landi D, Di Mario C. MitraClip Implantation to Treat Early Recurrence of Mitral Regurgitation After Percutaneous Direct Annuloplasty With Cardioband. JACC Cardiovasc Interv. 2018;11(14):1416–7. doi:.https://doi.org/10.1016/j.jcin.2018.04.049
  23. Rogers JH, Boyd WD, Smith TWR, Ebner AA, Bolling SF. Combined MitraClip Edge-to-Edge Repair With Millipede IRIS Mitral Annuloplasty. JACC Cardiovasc Interv. 2018;11(3):323–4. doi:.https://doi.org/10.1016/j.jcin.2017.11.007
  24. Siminiak T, Wu JC, Haude M, Hoppe UC, Sadowski J, Lipiecki J, et al. Treatment of functional mitral regurgitation by percutaneous annuloplasty: results of the TITAN Trial. Eur J Heart Fail. 2012;14(8):931–8. doi:.https://doi.org/10.1093/eurjhf/hfs076
  25. Rogers JH, Thomas M, Morice MC, Narbute I, Zabunova M, Hovasse T, et al. Treatment of Heart Failure With Associated Functional Mitral Regurgitation Using the ARTO System: Initial Results of the First-in-Human MAVERIC Trial (Mitral Valve Repair Clinical Trial). JACC Cardiovasc Interv. 2015;8(8):1095–104. doi:.https://doi.org/10.1016/j.jcin.2015.04.012
  26. Praz F, Windecker S, Huber C, Carrel T, Wenaweser P. Expanding Indications of Transcatheter Heart Valve Interventions. JACC Cardiovasc Interv. 2015;8(14):1777–96. doi:.https://doi.org/10.1016/j.jcin.2015.08.015
  27. Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Schofer N, Eschenbach L, et al. Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings. J Am Coll Cardiol. 2017;70(9):1121–31. doi:.https://doi.org/10.1016/j.jacc.2017.07.714
  28. Guerrero M, Dvir D, Himbert D, Urena M, Eleid M, Wang DD, et al. Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification: Results From the First Multicenter Global Registry. JACC Cardiovasc Interv. 2016;9(13):1361–71. doi:.https://doi.org/10.1016/j.jcin.2016.04.022
  29. Blanke P, Naoum C, Webb J, Dvir D, Hahn RT, Grayburn P, et al. Multimodality Imaging in the Context of Transcatheter Mitral Valve Replacement: Establishing Consensus Among Modalities and Disciplines. JACC Cardiovasc Imaging. 2015;8(10):1191–208. doi:.https://doi.org/10.1016/j.jcmg.2015.08.004
  30. Blanke P, Naoum C, Dvir D, Bapat V, Ong K, Muller D, et al. Predicting LVOT Obstruction in Transcatheter Mitral Valve Implantation: Concept of the Neo-LVOT. JACC Cardiovasc Imaging. 2017;10(4):482–5. doi:.https://doi.org/10.1016/j.jcmg.2016.01.005
  31. Theriault-Lauzier PP, Dorfmeister M, Mylotte D, Andalib A, Spaziano M, Blanke P, et al. Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 2: geometrical measurements in patients with functional mitral regurgitation. EuroIntervention. 2015;11(7).

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