Skip to main content
Log in

Transcatheter edge to edge repair using the ease-of-use valve clamp system for functional mitral regurgitation: a primary report

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The ValveClamp system is a novel edge-to-edge mitral valve repair system designed for the ease of operation. We report the outcomes of our initial experience of treating functional mitral regurgitation (MR) with the ValveClamp system.

Methods

The subjects of this study were patients with symptomatic functional MR despite standard medical therapy, who were treated with transapical ValveClamp implantation. The patients were divided into an atrial functional mitral regurgitation (AFMR) group and a ventricular functional mitral regurgitation (VFMR) group. Clinical and echocardiographic outcomes were evaluated at baseline and then at the 3-month follow up.

Results

Twelve patients, with a median age of 71 years (range 65–78 years), were assigned to the AFMR group (n = 5) or the VFMR group (n = 7). The device implantation rate was 100%, and 10 (83.3%) patients required implantation of only one clamp. The catheter time was less than 10 min in half of the patients, the fastest time being 5 min. There were no procedure-related complications. At the 3-month follow up, all patients were free from all-cause mortality, surgery, and rehospitalization. MR improved to ≤ 2 + in all 12 patients with MR grade 3 + or 4 + at baseline, (100%) and to ≤ 1 + in 9 of these patients (75%), with a low-pressure gradient. The left atrial diameter and the left ventricular end diastolic diameter decreased significantly in both the AFMR and VFMR groups. The left ventricular eject fraction at the 3-month follow up showed a rising trend in both the AFMR and VFMR groups, whereas PASP decreased remarkably. All 12 patients with baseline NYHA functional class III/IV (100%) showed improvement of at least 1 class, and 2 of these patients (16.7%) showed improvement of at least 2 classes.

Conclusions

The ValveClamp system is simple and effective for transapical transcatheter edge to edge repair in patients with functional MR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Dziadzko V, Clavel MA, Dziadzko M, Medina-Inojosa JR, Michelena H, Maalouf J, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet. 2018;391(10124):960–9.

    Article  Google Scholar 

  2. Dziadzko V, Dziadzko M, Medina-Inojosa JR, Benfari G, Michelena HI, Crestanello JA, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J. 2019;40(27):2194–202.

    Article  Google Scholar 

  3. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2021;77(4):450–500.

    Article  Google Scholar 

  4. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021;62:209.

    Google Scholar 

  5. Carabello BA. MitraClip and tertiary mitral regurgitation-mitral regurgitation gets curiouser and curiouser. JAMA Cardiol. 2019;4(4):307–8.

    Article  Google Scholar 

  6. Sorajja P, Vemulapalli S, Feldman T, Mack M, Holmes DR, Stebbins A, et al. Outcomes with transcatheter mitral valve repair in the united states: an STS/ACC TVT registry report. J Am Coll Cardiol. 2017;70(19):2315–27.

    Article  Google Scholar 

  7. Marquetand C, Reil JC, Saad M, Langer HF, Patzelt J. Treatment of recurrent MR by MitraClip XTR in a patient with a PASCAL device. JACC Cardiovasc Interv. 2019;12(24):e219–21.

    Article  Google Scholar 

  8. Raghunathan D, Garcia-Sayan E, Dhoble A, Smalling R. First-in-human report of MitraClip G4 implantation for severe degenerative mitral regurgitation. Catheter Cardiovasc Interv. 2020;96(3):E395–7.

    Article  Google Scholar 

  9. Praz F, Braun D, Unterhuber M, Spirito A, Orban M, Brugger N, et al. Edge-to-edge mitral valve repair with extended clip arms: early experience from a multicenter observational study. JACC Cardiovasc Interv. 2019;12(14):1356–65.

    Article  Google Scholar 

  10. Pan W, Pan C, Jilaihawi H, Wei L, Tang Y, Zhou D, et al. A novel user-friendly transcatheter edge-to-edge mitral valve repair device in a porcine model. Catheter Cardiovasc Interv. 2019;93(7):1354–60.

    Article  Google Scholar 

  11. Long Y, Pan W, Pan C, Li W, Zhou D, Ge J. Real-time echocardiographic guidance for transcatheter repair noncentral mitral regurgitation using the novel ValveClamp system. J Card Surg. 2021;36(11):4378–80.

    Article  Google Scholar 

  12. Ge Z, Pan W, Zhou D, Li W, Wei L, Liu X, et al. Effect of a novel transcatheter edge-to-edge repair device on the three-dimensional geometry of mitral valve in degenerative mitral regurgitation. Catheter Cardiovasc Interv. 2021;97(1):177–85.

    Article  Google Scholar 

  13. Ge Z, Pan C, Li W, Zhou D, Pan W, Wei L, et al. Real-time monitoring and step-by-step guidance for transapical mitral valve edge-to-edge repair using transesophageal echocardiography. J Interv Cardiol. 2021;2021:6659261.

    Article  Google Scholar 

  14. Pan W, Zhou D, Wu Y, Guo Y, Pan X, Pan C, et al. First-in-human results of a novel user-friendly transcatheter edge-to-edge mitral valve repair device. JACC Cardiovasc Interv. 2019;12(23):2441–3.

    Article  Google Scholar 

  15. Long Y, Pan W, Pan C, Li W, Wei L, Wu Y, et al. Transcatheter mitral valve edge-to-edge repair with a novel system. Int Heart J. 2022;63(1):23–9.

    Article  Google Scholar 

  16. Asch FM, Grayburn PA, Siegel RJ, Kar S, Lim DS, Zaroff JG, et al. Echocardiographic outcomes after transcatheter leaflet approximation in patients with secondary mitral regurgitation: the COAPT trial. J Am Coll Cardiol. 2019;74(24):2969–79.

    Article  CAS  Google Scholar 

  17. Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 1: clinical trial design principles: a consensus document from the mitral valve academic research consortium. J Am Coll Cardiol. 2015;66(3):278–307.

    Article  Google Scholar 

  18. Garcia-Sayan E, Raghunathan D, Li FM, Dhoble A, Sheu RD, Jelacic S, et al. Initial experience with the fourth generation MitraClip™: outcomes, procedural aspects, and considerations for device selection. Catheter Cardiovasc Interv. 2021;98(4):E626–36.

    Google Scholar 

  19. Lim DS, Kar S, Spargias K, Kipperman RM, O’Neill WW, Ng MKC, et al. Transcatheter valve repair for patients with mitral regurgitation: 30-day results of the CLASP study. JACC Cardiovasc Interv. 2019;12(14):1369–78.

    Article  Google Scholar 

  20. Chakravarty T, Makar M, Patel D, Oakley L, Yoon SH, Stegic J, et al. Transcatheter edge-to-edge mitral valve repair with the MitraClip G4 system. JACC Cardiovasc Interv. 2020;13(20):2402–14.

    Article  Google Scholar 

  21. Kaur S, Sadana D, Patel J, Gad M, Sankaramangalam K, Krishnaswamy A, et al. Atrial fibrillation and transcatheter repair of functional mitral regurgitation: evidence from a meta-regression. JACC Cardiovasc Interv. 2020;13(20):2374–84.

    Article  Google Scholar 

  22. Godino C, Sisinni A, Pivato CA, Adamo M, Taramasso M, Parlati A. Prognostic value of pre-operative atrial fibrillation in patients with secondary mitral regurgitation undergoing MitraClip implantation. Am J Cardiol. 2021;143:51–9.

    Article  Google Scholar 

  23. Gertz ZM, Herrmann HC, Lim DS, Kar S, Kapadia SR, Reed GW, et al. Implications of atrial fibrillation on the mechanisms of mitral regurgitation and response to MitraClip in the COAPT trial. Circ Cardiovasc Interv. 2021;14(4): e010300.

    Article  CAS  Google Scholar 

  24. Yoshida J, Ikenaga H, Nagaura T, Utsunomiya H, Kawai M, Makar M, et al. Impact of percutaneous edge-to-edge repair in patients with atrial functional mitral regurgitation. Circ J. 2021;85(7):1001–10.

    Article  Google Scholar 

Download references

Funding

This study was supported by National Key R&D Program of China (2020YFC2008100).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lihua Guan.

Ethics declarations

Conflict of interest

Dr. Zhou and Dr. Pan are consultants for Hanyu Medical Technology. The other authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 7060 KB)

Supplementary file2 (MOV 14268 KB)

Supplementary file3 (MOV 13242 KB)

Supplementary file4 (MOV 11130 KB)

Supplementary file5 (MOV 14510 KB)

Supplementary file6 (MOV 8547 KB)

Supplementary file7 (MOV 3705 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, W., Long, Y., Pan, W. et al. Transcatheter edge to edge repair using the ease-of-use valve clamp system for functional mitral regurgitation: a primary report. Surg Today 53, 90–97 (2023). https://doi.org/10.1007/s00595-022-02559-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02559-8

Keywords

Navigation