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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review

Eduardo Martinez-Gomez1, Angela McInerney1, Gabriela Tirado-Conte1

  • 1Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 15, 2021
PubMed
Abstract

Insights

Percutaneous mitral valve repair using MitraClip is feasible in critically ill patients with severe mitral regurgitation. This approach shows promising results, including reduced regurgitation and shorter support durations, though further trials are needed.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Limited data exist on percutaneous mitral valve repair (PMVr) in hemodynamically unstable patients.
  • Moderate-to-severe mitral regurgitation (MR) poses significant risks in critically ill individuals.

Purpose of the Study:

  • To systematically review the characteristics, management, and outcomes of critically ill patients undergoing PMVr with the MitraClip device.
  • To evaluate the efficacy and safety of MitraClip in high-risk patients with severe MR.

Main Methods:

  • Systematic review of publications from 2003 to December 2020.
  • Inclusion criteria: critically ill patients in cardiogenic shock or acute refractory pulmonary edema with significant MR.
  • Analysis of 40 publications involving 254 patients.

Main Results:

  • High device success rate (93.7%) with significant MR reduction (91.8% to ≤Grade 2).
  • Median weaning time from support was 2 days; in-hospital mortality was 12.6%.
  • 12-month overall mortality was 39.1%, with persistent MR reduction in survivors.

Conclusions:

  • MitraClip is a technically feasible and potentially viable option for high-risk patients with severe MR and hemodynamic instability.
  • Prospective trials are necessary to confirm these findings and establish MitraClip's definitive value in this population.
Keywords:
MitraClipacute mitral regurgitationcardiogenic shockmitral edge-to-edge repairmortality

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