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Treatment of secondary mitral regurgitation by transcatheter edge-to-edge repair using MitraClip

  • Review Article–Cardiology
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Abstract

Transcatheter edge-to-edge repair (TEER) is becoming the standard invasive treatment for ventricular functional mitral regurgitation (MR). It is necessary to determine the severity of MR before treatment with MitraClip; however, the severity of secondary MR is usually underestimated compared with that of primary MR and varies temporally. Therefore, to accurately determine the severity of MR, it is important to correctly use the algorithm of the guidelines for valvular heart disease and aggressively perform stress echocardiography. Before performing TEER, the difficulty of the procedure should be evaluated. First, morphological features that make TEER unsuitable, such as cleft of the mitral leaflet, mitral stenosis (MS), or perforation of the mitral leaflet, should be checked. The mitral valve orifice area, transmitral valve pressure gradient, coaptation depth, coaptation length, and posterior leaflet length should be measured to determine the difficulty of the procedure based on the inclusion criteria of Endovascular Valve Edge-to-Edge Repair Study II and the German consensus. After MitraClip implantation, in addition to assessing the severity of MS and residual MR, the pulmonary venous flow pattern and stroke volume should be evaluated to comprehensively assess whether TEER improves the hemodynamics. MitraClip has also been used to treat atrial functional MR, another type of secondary MR. Several reports suggest that MitraClip is effective for atrial functional MR; however, evidence is still being accumulated.

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References

  1. Carpentier A. Cardiac valve surgery—the “French correction.” J Thorac Cardiovasc Surg. 1983;86:323–37.

    Article  CAS  PubMed  Google Scholar 

  2. El Sabbagh A, Reddy YNV, Nishimura RA. Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions. JACC Cardiovasc Imaging. 2018;11:628–43.

    Article  PubMed  Google Scholar 

  3. Izumi C, Eishi K, et al. JCS/JATS/JSVS/JSCS 2020 Guideline on the Management of Valvular Heart Disease. The Japanese Circulation Society/The Japanese Association for Thoracic Surgery/the Japanese Society for Vascular Surgery/The Japanese Society for Cardiovascular Surgery Joint Guidelines. http://www.j-circ.or.jp/guideline/pdf/JCS2020_Izumi_Eishi.pdf

  4. Writing Committee M, Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77:e25–197.

    Article  Google Scholar 

  5. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022;43:561–632.

    Article  PubMed  Google Scholar 

  6. Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 2016;374:1932–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med. 2016;374:344–53.

    Article  CAS  PubMed  Google Scholar 

  8. Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379:2307–18.

    Article  PubMed  Google Scholar 

  9. Mack MJ, Lindenfeld J, Abraham WT, et al. 3-Year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol. 2021;77:1029–40.

    Article  PubMed  Google Scholar 

  10. Iung B, Armoiry X, Vahanian A, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years. Eur J Heart Fail. 2019;21:1619–27.

    Article  PubMed  Google Scholar 

  11. Otsuji Y, Handschumacher MD, Schwammenthal E, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation. 1997;96:1999–2008.

    Article  CAS  PubMed  Google Scholar 

  12. Otsuji Y, Handschumacher MD, Liel-Cohen N, et al. Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation. J Am Coll Cardiol. 2001;37:641–8.

    Article  CAS  PubMed  Google Scholar 

  13. Kwan J, Shiota T, Agler DA, et al. Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study. Circulation. 2003;107:1135–40.

    Article  PubMed  Google Scholar 

  14. Levine RA, Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation. 2005;112:745–58.

    Article  PubMed  Google Scholar 

  15. Stone GW, Vahanian AS, Adams DH, 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;66:278–307.

    Article  PubMed  Google Scholar 

  16. Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:307–32.

  17. Mauri L, Garg P, Massaro JM, et al. The EVEREST II Trial: design and rationale for a randomized study of the evalve mitraclip system compared with mitral valve surgery for mitral regurgitation. Am Heart J. 2010;160:23–9.

    Article  PubMed  Google Scholar 

  18. Kagiyama N, Shrestha S. Echocardiographic assessment of mitral regurgitation. J Med Ultrason. 2020;47:59–70.

    Article  Google Scholar 

  19. Matsumura Y, Fukuda S, Tran H, et al. Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography: difference between functional mitral regurgitation and prolapse regurgitation. Am Heart J. 2008;155:231–8.

    Article  PubMed  Google Scholar 

  20. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30:303–71.

    Article  PubMed  Google Scholar 

  21. Suzuki K, Hirano Y, Yamada H, et al. Practical guidance for the implementation of stress echocardiography. J Echocardiogr. 2018;16:105–29.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lancellotti P, Pellikka PA, Budts W, et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30:101–38.

    Article  PubMed  Google Scholar 

  23. Izumo M, Kuwata S, Ishibashi Y, et al. Prognostic impact of transcatheter mitral valve repair in patients with exercise-induced secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging. 2021;22:530–8.

    Article  PubMed  Google Scholar 

  24. Boekstegers P, Hausleiter J, Baldus S, et al. Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system. Clin Res Cardiol. 2014;103:85–96.

    Article  CAS  PubMed  Google Scholar 

  25. Oguz D, Padang R, Rashedi N, et al. Risk for increased mean diastolic gradient after transcatheter edge-to-edge mitral valve repair: a quantitative three-dimensional transesophageal echocardiographic analysis. J Am Soc Echocardiogr. 2021;34:595–603.

    Article  PubMed  Google Scholar 

  26. Neuss M, Schau T, Isotani A, et al. Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure. JACC Cardiovasc Interv. 2017;10:931–9.

    Article  PubMed  Google Scholar 

  27. Feldman T, Kar S, Rinaldi M, et al. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol. 2009;54:686–94.

    Article  PubMed  Google Scholar 

  28. Flachskampf FA, Wouters PF, Edvardsen T, et al. Recommendations for transoesophageal echocardiography: EACVI update 2014. Eur Heart J Cardiovasc Imaging. 2014;15:353–65.

    Article  PubMed  Google Scholar 

  29. Chakravarty T, Makar M, Patel D, et al. Transcatheter edge-to-edge mitral valve repair with the MitraClip G4 system. JACC Cardiovasc Interv. 2020;13:2402–14.

    Article  PubMed  Google Scholar 

  30. Itabashi Y, Utsunomiya H, Kubo S, et al. Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair. J Cardiol. 2018;71:336–45.

    Article  PubMed  Google Scholar 

  31. Utsunomiya H, Itabashi Y, Kobayashi S, et al. Effect of percutaneous edge-to-edge repair on mitral valve area and its association with pulmonary hypertension and outcomes. Am J Cardiol. 2017;120:662–9.

    Article  PubMed  Google Scholar 

  32. Maisano F, Redaelli A, Pennati G, et al. The hemodynamic effects of double-orifice valve repair for mitral regurgitation: a 3D computational model. Eur J Cardiothorac Surg. 1999;15:419–25.

    Article  CAS  PubMed  Google Scholar 

  33. Zoghbi WA, Asch FM, Bruce C, et al. Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2019;32:431–75.

    Article  PubMed  Google Scholar 

  34. Itakura K, Utsunomiya H, Takemoto H, et al. Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation. Eur Heart J Cardiovasc Imaging. 2021;22:964–73.

    Article  PubMed  Google Scholar 

  35. Ikenaga H, Yoshida J, Hayashi A, et al. Usefulness of intraprocedural pulmonary venous flow for predicting recurrent mitral regurgitation and clinical outcomes after percutaneous mitral valve repair with the MitraClip. JACC Cardiovasc Interv. 2019;12:140–50.

    Article  PubMed  Google Scholar 

  36. Kubo S, Nakamura M, Shiota T, et al. Impact of forward stroke volume response on clinical and structural outcomes after percutaneous mitral valve repair with MitraClip. Circ Cardiovasc Interv. 2017;10:e00490.

    Article  Google Scholar 

  37. Obadia J-F, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018;379:2297–306.

    Article  PubMed  Google Scholar 

  38. Asch FM, Grayburn PA, Siegel RJ, et al. Echocardiographic outcomes after transcatheter leaflet approximation in patients with secondary mitral regurgitation: the COAPT trial. J Am Coll Cardiol. 2019;74:2969–79.

    Article  CAS  PubMed  Google Scholar 

  39. Deferm S, Bertrand PB, Verbrugge FH, et al. Atrial functional mitral regurgitation: JACC review topic of the week. J Am Coll Cardiol. 2019;73:2465–76.

    Article  PubMed  Google Scholar 

  40. Kagiyama N, Mondillo S, Yoshida K, et al. Subtypes of atrial functional mitral regurgitation: imaging insights into their mechanisms and therapeutic implications. JACC Cardiovasc Imaging. 2020;13:820–35.

    Article  PubMed  Google Scholar 

  41. Yoshida J, Ikenaga H, Nagaura T, et al. Impact of percutaneous edge-to-edge repair in patients with atrial functional mitral regurgitation. Circ J. 2021;85:1001.

    Article  PubMed  Google Scholar 

  42. Ikenaga H, Higashihara T, Itakura K, et al. Successful MitraClip therapy for atrial functional mitral regurgitation with severe mitral annular calcification. JACC Cardiovasc Interv. 2021;14:101–2.

    Article  PubMed  Google Scholar 

  43. Nagaura T, Hayashi A, Yoshida J, et al. Percutaneous edge-to-edge repair for atrial functional mitral regurgitation: a real-time 3-dimensional transesophageal echocardiography study. JACC Cardiovasc Imaging. 2019;12:1881–3.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Dr. Yuki Izumi for providing valuable echocardiographic images of mitral regurgitation cases. We also would like to thank Editage (http://www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Minamikoshigaya 2-1-50, Koshigaya, Saitama, 343-8555, Japan

    Yuji Itabashi, Sayuki Kobayashi, Yukiko Mizutani & Isao Taguchi

  2. Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan

    Kei Torikai

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  1. Yuji Itabashi
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Correspondence to Yuji Itabashi.

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Itabashi, Y., Kobayashi, S., Mizutani, Y. et al. Treatment of secondary mitral regurgitation by transcatheter edge-to-edge repair using MitraClip. J Med Ultrasonics 49, 389–403 (2022). https://doi.org/10.1007/s10396-022-01227-1

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  • DOI: https://doi.org/10.1007/s10396-022-01227-1

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