Mitral Valve Regurgitation—MitraClip

  • Friso Alexander Kortlandt
  • Martin John Swaans
  • Jan Antoon Simon van der Heyden


Percutaneous edge-to-edge repair of the mitral valve using the MitraClip was established as a novel alternative for the treatment of symptomatic moderate to severe mitral regurgitation. Several studies have shown outstanding short-term efficacy and safety results for a wide range of subgroups of patients. While initially otherwise healthy patients with intrinsic valvular disease have been treated, more recently patients with functional disease who were deemed too high risk to undergo surgery were also included. Contemporary results suggest MitraClip therapy to be superior to conservative therapy and non-inferior to surgical treatment; however, it must be emphasized that evidence comparing the different strategies is still sparse and only the results from a single randomized controlled trial have so far been published. In addition, because efficacy outcomes differ between different subgroups, it appears premature to draw up general guidelines for indications and decision-making. In the near future, outcomes of several randomized controlled trials and large registries are expected to clarify the indications for the MitraClip in the treatment of mitral regurgitation.


  1. 1.
    Mirabel M, Iung B, Baron G, Messika-Zeitoun D, Detaint 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.CrossRefGoogle Scholar
  2. 2.
    Condado J, Acquatella H, Rodriguez L, Whitlow P, Velez-Gimo M, St. Goar F. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv. 2006;67(2):323–5.CrossRefGoogle Scholar
  3. 3.
    Maisano F, Vigano G, Blasio A, Colombo A, Calabrese C, Alfieri O. Surgical isolated edge-to-edge mitral valve repair without annuloplasty: clinical proof of the principle for an endovascular approach. EuroIntervention. 2006;2(2):181–6.PubMedGoogle Scholar
  4. 4.
    Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, 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(8):686–94.CrossRefGoogle Scholar
  5. 5.
    Feldman T, Kar S, Elmariah S, Smart SC, Trento A, Siegel RJ, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol. 2015;66(25):2844–54.CrossRefGoogle Scholar
  6. 6.
    Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, 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(4):307–32.CrossRefGoogle Scholar
  7. 7.
    Altiok E, Hamada S, Brehmer K, Kuhr K, Reith S, Becker M, et al. Analysis of procedural effects of percutaneous edge-to-edge mitral valve repair by 2D and 3D echocardiography. Circ Cardiovasc Imaging. 2012;5(6):748–55.CrossRefGoogle Scholar
  8. 8.
    Armoiry X, Brochet E, Lefevre T, Guerin P, Dumonteil N, Himbert D, et al. Initial French experience of percutaneous mitral valve repair with the MitraClip: a multicentre national registry. Arch Cardiovasc Dis. 2013;106(5):287–94.CrossRefGoogle Scholar
  9. 9.
    Attizzani GF, Ohno Y, Capodanno D, Cannata S, Dipasqua F, Imme S, et al. Extended use of percutaneous edge-to-edge mitral valve repair beyond EVEREST (Endovascular Valve Edge-to-Edge Repair) criteria: 30-day and 12-month clinical and echocardiographic outcomes from the GRASP (Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation) registry. JACC Cardiovasc Interv. 2015;8(1 Pt A):74–82.CrossRefGoogle Scholar
  10. 10.
    Auricchio A, Schillinger W, Meyer S, Maisano F, Hoffmann R, Ussia GP, et al. Correction of mitral regurgitation in nonresponders to cardiac resynchronization therapy by MitraClip improves symptoms and promotes reverse remodeling. J Am Coll Cardiol. 2011;58(21):2183–9.CrossRefGoogle Scholar
  11. 11.
    Bozdag-Turan I, Paranskaya L, Birkemeyer R, Turan RG, Kische S, Akin I, et al. Percutaneous mitral repair with the MitraClip system in patients with mild-to-moderate and severe heart failure: a single-centre experience. Cardiovasc Ther. 2014;32(2):66–73.CrossRefGoogle Scholar
  12. 12.
    Braun D, Lesevic H, Orban M, Michalk F, Barthel P, Hoppe K, et al. Percutaneous edge-to-edge repair of the mitral valve in patients with degenerative versus functional mitral regurgitation. Catheter Cardiovasc Interv. 2014;84(1):137–46.CrossRefGoogle Scholar
  13. 13.
    Chan PH, She HL, Alegria-Barrero E, Moat N, Di Mario C, Franzen O. Real-world experience of MitraClip for treatment of severe mitral regurgitation. Circ J. 2012;76(10):2488–93.CrossRefGoogle Scholar
  14. 14.
    Gaemperli O, Moccetti M, Surder D, Biaggi P, Hurlimann D, Kretschmar O, et al. Acute haemodynamic changes after percutaneous mitral valve repair: relation to mid-term outcomes. Heart. 2012;98(2):126–32.CrossRefGoogle Scholar
  15. 15.
    Maisano F, Franzen O, Baldus S, Schafer U, Hausleiter J, Butter C, et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol. 2013;62(12):1052–61.CrossRefGoogle Scholar
  16. 16.
    Neuss M, Schau T, Schoepp M, Seifert M, Holschermann F, Meyhofer J, et al. Patient selection criteria and midterm clinical outcome for MitraClip therapy in patients with severe mitral regurgitation and severe congestive heart failure. Eur J Heart Fail. 2013;15(7):786–95.CrossRefGoogle Scholar
  17. 17.
    Nickenig G, Estevez-Loureiro R, Franzen O, Tamburino C, Vanderheyden M, Luscher TF, et al. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 pilot European sentinel registry. J Am Coll Cardiol. 2014;64(9):875–84.CrossRefGoogle Scholar
  18. 18.
    Pleger ST, Schulz-Schonhagen M, Geis N, Mereles D, Chorianopoulos E, Antaredja M, et al. One year clinical efficacy and reverse cardiac remodelling in patients with severe mitral regurgitation and reduced ejection fraction after MitraClip implantation. Eur J Heart Fail. 2013;15(8):919–27.CrossRefGoogle Scholar
  19. 19.
    Rudolph V, Knap M, Franzen O, Schluter M, de Vries T, Conradi L, et al. Echocardiographic and clinical outcomes of MitraClip therapy in patients not amenable to surgery. J Am Coll Cardiol. 2011;58(21):2190–5.CrossRefGoogle Scholar
  20. 20.
    Schillinger W, Hunlich M, Baldus S, Ouarrak T, Boekstegers P, Hink U, et al. Acute outcomes after MitraClip therapy in highly aged patients: results from the German TRAnscatheter mitral valve interventions (TRAMI) registry. EuroIntervention. 2013;9(1):84–90.CrossRefGoogle Scholar
  21. 21.
    Surder D, Pedrazzini G, Gaemperli O, Biaggi P, Felix C, Rufibach K, et al. Predictors for efficacy of percutaneous mitral valve repair using the MitraClip system: the results of the MitraSwiss registry. Heart. 2013;99(14):1034–40.CrossRefGoogle Scholar
  22. 22.
    Taramasso M, Maisano F, Latib A, Denti P, Buzzatti N, Cioni M, et al. Clinical outcomes of MitraClip for the treatment of functional mitral regurgitation. EuroIntervention. 2014;10(6):746–52.CrossRefGoogle Scholar
  23. 23.
    Triantafyllis AS, Kortlandt F, Bakker AL, Swaans MJ, Eefting FD, van der Heyden JA, et al. Long-term survival and preprocedural predictors of mortality in high surgical risk patients undergoing percutaneous mitral valve repair. Catheter Cardiovasc Interv. 2016;87(3):467–75.CrossRefGoogle Scholar
  24. 24.
    Yeo KK, Yap J, Yamen E, Muda N, Tay E, Walters DL, et al. Percutaneous mitral valve repair with the MitraClip: early results from the MitraClip Asia-Pacific registry (MARS). EuroIntervention. 2014;10(5):620–5.CrossRefGoogle Scholar
  25. 25.
    Franzen O, van der Heyden J, Baldus S, Schluter M, Schillinger W, Butter C, et al. MitraClip(R) therapy in patients with end-stage systolic heart failure. Eur J Heart Fail. 2011;13(5):569–76.CrossRefGoogle Scholar
  26. 26.
    Pleger ST, Mereles D, Schulz-Schonhagen M, Krumsdorf U, Chorianopoulos E, Rottbauer W, et al. Acute safety and 30-day outcome after percutaneous edge-to-edge repair of mitral regurgitation in very high-risk patients. Am J Cardiol. 2011;108(10):1478–82.CrossRefGoogle Scholar
  27. 27.
    Whitlow PL, Feldman T, Pedersen WR, Lim DS, Kipperman R, Smalling R, et al. Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (endovascular valve edge-to-edge repair) high risk study. J Am Coll Cardiol. 2012;59(2):130–9.CrossRefGoogle Scholar
  28. 28.
    Boekstegers P, Hausleiter J, Baldus S, von Bardeleben RS, Beucher H, Butter C, et al. Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system. Clin Res Cardiol. 2014;103(2):85–96.CrossRefGoogle Scholar
  29. 29.
    Glower DD, Kar S, Trento A, Lim DS, Bajwa T, Quesada R, et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 2014;64(2):172–81.CrossRefGoogle Scholar
  30. 30.
    Ling LH, Enriquez-Sarano M, Seward JB, Orszulak TA, Schaff HV, Bailey KR, et al. Early surgery in patients with mitral regurgitation due to flail leaflets: a long-term outcome study. Circulation. 1997;96(6):1819–25.CrossRefGoogle Scholar
  31. 31.
    Takagi H, Ando T, Umemoto T, ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. A review of comparative studies of MitraClip versus surgical repair for mitral regurgitation. Int J Cardiol. 2016;228:289–94.CrossRefGoogle Scholar
  32. 32.
    Eleid MF, Reeder GS, Malouf JF, Lennon RJ, Pislaru SV, Nkomo VT, et al. The learning curve for transcatheter mitral valve repair with MitraClip. J Interv Cardiol. 2016;29(5):539–45.CrossRefGoogle Scholar
  33. 33.
    Giannini C, Fiorelli F, De Carlo M, Guarracino F, Faggioni M, Giordano P, et al. Comparison of percutaneous mitral valve repair versus conservative treatment in severe functional mitral regurgitation. Am J Cardiol. 2016;117(2):271–7.CrossRefGoogle Scholar
  34. 34.
    Munkholm-Larsen S, Wan B, Tian DH, Kearney K, Rahnavardi M, Dixen U, et al. A systematic review on the safety and efficacy of percutaneous edge-to-edge mitral valve repair with the MitraClip system for high surgical risk candidates. Heart. 2014;100(6):473–8.CrossRefGoogle Scholar
  35. 35.
    Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352(9):875–83.CrossRefGoogle Scholar
  36. 36.
    Wan B, Rahnavardi M, Tian DH, Phan K, Munkholm-Larsen S, Bannon PG, et al. A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation. Ann Cardiothorac Surg. 2013;2(6):683–92.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Taramasso M, Buzzatti N, La Canna G, Colombo A, Alfieri O, Maisano F. Interventional vs. surgical mitral valve therapy. Which technique for which patient? Herz. 2013;38(5):460–6.CrossRefGoogle Scholar
  38. 38.
    De Bonis M, Lapenna E, Buzzatti N, La Canna G, Denti P, Pappalardo F, et al. Optimal results immediately after MitraClip therapy or surgical edge-to-edge repair for functional mitral regurgitation: are they really stable at 4 years? Eur J Cardiothorac Surg. 2016;50(3):488–94.CrossRefGoogle Scholar
  39. 39.
    Van den Branden BJ, Swaans MJ, Post MC, Rensing BJ, Eefting FD, Jaarsma W, et al. Percutaneous edge-to-edge mitral valve repair in high-surgical-risk patients: do we hit the target? JACC Cardiovasc Interv. 2012;5(1):105–11.CrossRefGoogle Scholar
  40. 40.
    Philip F, Athappan G, Tuzcu EM, Svensson LG, Kapadia SR. MitraClip for severe symptomatic mitral regurgitation in patients at high surgical risk: a comprehensive systematic review. Catheter Cardiovasc Interv. 2014;84(4):581–90.CrossRefGoogle Scholar
  41. 41.
    Swaans MJ, Bakker AL, Alipour A, Post MC, Kelder JC, de Kroon TL, et al. Survival of transcatheter mitral valve repair compared with surgical and conservative treatment in high-surgical-risk patients. JACC Cardiovasc Interv. 2014;7(8):875–81.CrossRefGoogle Scholar
  42. 42.
    Velazquez EJ, Samad Z, Al-Khalidi HR, Sangli C, Grayburn PA, Massaro JM, et al. The MitraClip and survival in patients with mitral regurgitation at high risk for surgery: a propensity-matched comparison. Am Heart J. 2015;170(5):1050–9. e3CrossRefGoogle Scholar
  43. 43.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1–e132.CrossRefGoogle Scholar
  44. 44.
    Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;42(4):S1–44.CrossRefGoogle Scholar
  45. 45.
    de Waha S, Seeburger J, Ender J, Desch S, Eitel I, Reinhardt A, et al. Deep sedation versus general anesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system. Clin Res Cardiol. 2016;105(6):535–43.CrossRefGoogle Scholar
  46. 46.
    Alipour A, Swaans MJ, Post MC, Rensing BJ, Eefting FD, Van der Heyden JA. Unintentional sealing of the mitral valve with a second MitraClip. “Once bitten, twice shy”. EuroIntervention. 2015;11(5):597.CrossRefGoogle Scholar
  47. 47.
    Zamorano JL, Badano LP, Bruce C, Chan KL, Goncalves A, Hahn RT, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. Eur Heart J. 2011;32(17):2189–214.CrossRefGoogle Scholar
  48. 48.
    Swaans MJ, van den Branden BJ, Post MC, van der Heyden JAS. The percutaneous mitral valve repair procedure – the role of echocardiographic guidance. Eur Cardiol. 2011;7(3):177–80. Scholar
  49. 49.
    Chitsaz S, Jumaen M, Dayah T, Rajagopal K, Kar B. Late mitraclip embolization a new cause of st-segment-elevation myocardial infarction. Circ Cardiovasc Interv. 2016;9(11). pii:e004271.Google Scholar
  50. 50.
    Bilge M, Alsancak Y, Ali S, Duran M, Bicer H. An extremely rare but possible complication of MitraClip: embolization of clip during follow-up. Anatol J Cardiol. 2016;16(8):636–8.CrossRefGoogle Scholar
  51. 51.
    Baldus S. A multicenter, randomized, controlled study to assess mitral valve reconstruction for advanced insuffieciency of functional or ischemic origin (MATTERHORN).
  52. 52.
    Mack M, Stone G, Abraham WT, Lindenfeld J. Cardiovascular outcomes assessment of the MitraClip percutaneous therapy for heart failure patients with functional mitral regurgitation (COAPT).
  53. 53.
    Obadia JF. Multicentre study of percutaneous mitral valve repair mitraClip device in patients with severe secondary mitral regurgitation (MITRA-FR).
  54. 54.
    Anker S SW. A clinical evaluation of the safety and effectiveness of the MitraClip system in the treatment of clinically significant functional mitral regurgitation (Reshape-HF2).
  55. 55.
    Boerlage-vanDijk K, Wiegerinck EM, Araki M, Meregalli PG, Bindraban NR, Koch KT, et al. Predictors of outcome in patients undergoing MitraClip implantation: an aid to improve patient selection. Int J Cardiol. 2015;189:238–43.CrossRefGoogle Scholar
  56. 56.
    Capodanno D, Adamo M, Barbanti M, Giannini C, Laudisa ML, Cannata S, et al. Predictors of clinical outcomes after edge-to-edge percutaneous mitral valve repair. Am Heart J. 2015;170(1):187–95.CrossRefGoogle Scholar
  57. 57.
    Giannini C, Fiorelli F, Colombo A, De Carlo M, Weisz SH, Agricola E, et al. Right ventricular evaluation to improve survival outcome in patients with severe functional mitral regurgitation and advanced heart failure undergoing MitraClip therapy. Int J Cardiol. 2016;223:574–80.CrossRefGoogle Scholar
  58. 58.
    Matsumoto T, Nakamura M, Yeow WL, Hussaini A, Ram V, Makar M, et al. Impact of pulmonary hypertension on outcomes in patients with functional mitral regurgitation undergoing percutaneous edge-to-edge repair. Am J Cardiol. 2014;114(11):1735–9.CrossRefGoogle Scholar
  59. 59.
    Puls M, Tichelbacker T, Bleckmann A, Hunlich M, von der Ehe K, Beuthner BE, et al. Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip. EuroIntervention. 2014;9(12):1407–17.CrossRefGoogle Scholar
  60. 60.
    Biaggi P, Fernandez-Golfin C, Hahn R, Corti R. Hybrid imaging during transcatheter structural heart interventions. Curr Cardiovasc Imaging Rep. 2015;8(9):33.CrossRefGoogle Scholar
  61. 61.
    Ladich E, Michaels MB, Jones RM, McDermott E, Coleman L, Komtebedde J, et al. Pathological healing response of explanted MitraClip devices. Circulation. 2011;123(13):1418–27.CrossRefGoogle Scholar
  62. 62.
    De Bonis M, Lapenna E, Pozzoli A, Giacomini A, Alfieri O. Edge-to-edge surgical mitral valve repair in the era of MitraClip: what if the annuloplasty ring is missed? Curr Opin Cardiol. 2015. [Epub ahead of print].Google Scholar
  63. 63.
    Latib A, Ancona MB, Ferri L, Montorfano M, Mangieri A, Regazzoli D, et al. Percutaneous direct annuloplasty with cardioband to treat recurrent mitral regurgitation after MitraClip implantation. JACC Cardiovasc Interv. 2016;9(18):e191–2.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Friso Alexander Kortlandt
    • 1
  • Martin John Swaans
    • 1
  • Jan Antoon Simon van der Heyden
    • 1
  1. 1.St. Antonius HospitalNieuwegeinThe Netherlands

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