Skip to main content
SpringerLink
Log in

Atrioventricular valve disease: challenges and achievements in percutaneous treatment

  • Review
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Percutaneous treatment of atrioventricular (AV) valve disease has long been restricted to therapy of mitral stenosis, and was only lately expanded to mitral regurgitation. 15 years ago the MitraClip edge to edge repair was first applied to human pathology. In Europe, German centers were the first to widely adopt this technique in patients with mitral regurgitation and high or inappropriate risk for surgery. Given the exponential rise in implantation procedures, expertise of the operators and investigator initiated investigations substantially contributed to improvements in procedural processes and patient selection. Meanwhile, additional techniques to repair the mitral and tricuspid valve were introduced to German interventionalists, both reconstructive techniques as well as first experiences with transcatheter implantation of mitral valve bioprostheses. Of note, specialized Heart Valve referral Centers catalyzed the adoption of these techniques. This review summarizes the contributions of German Heart Centers to recent developments in percutaneous therapy of AV valve disease.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nkomo VT, Gardin JM, Skelton TN et al (2006) Burden of valvular heart diseases: a population-based study. Lancet 368:1005–1011

    Article  PubMed  Google Scholar 

  2. d’Arcy JL, Coffey S, Loudon MA et al (2016) Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study. Eur Heart J 37:3515–3522

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mirabel M, Iung B, Baron G et al (2007) What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J 28:1358–1365

    Article  PubMed  Google Scholar 

  4. Condado JA, Acquatella H, Rodriguez L et al (2006) Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv 67:323–325

    Article  PubMed  Google Scholar 

  5. Feldman T, Kar S, Elmariah S et al (2015) Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol 66:2844–2854

    Article  PubMed  Google Scholar 

  6. Feldman T, Foster E, Glower DD et al (2011) Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 364:1395–1406

    Article  PubMed  CAS  Google Scholar 

  7. Schofer J, Siminiak T, Haude M et al (2009) Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARILLON Mitral Annuloplasty Device European Union Study. Circulation 120:326–333

    Article  PubMed  PubMed Central  Google Scholar 

  8. Franzen O, Baldus S, Rudolph V et al (2010) Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction. Eur Heart J 31:1373–1381

    Article  PubMed  Google Scholar 

  9. Rudolph V, Knap M, Franzen O et al (2011) Echocardiographic and clinical outcomes of MitraClip therapy in patients not amenable to surgery. J Am Coll Cardiol 58:2190–2195

    Article  PubMed  Google Scholar 

  10. Baldus S, Schillinger W, Franzen O et al (2012) MitraClip therapy in daily clinical practice: initial results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail 14:1050–1055

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  12. Wallenborn J, Stork S, Herrmann S et al (2016) Prevalence of severe mitral regurgitation eligible for edge-to-edge mitral valve repair (MitraClip). Clin Res Cardiol 105:699–709

    Article  PubMed  Google Scholar 

  13. Schillinger W, Athanasiou T, Weicken N et al (2011) Impact of the learning curve on outcomes after percutaneous mitral valve repair with MitraClip and lessons learned after the first 75 consecutive patients. Eur J Heart Fail 13:1331–1339

    Article  PubMed  Google Scholar 

  14. Eggebrecht H, Mehta RH, Lubos E et al (2018) MitraClip in high- versus low-volume centers: an analysis from the German TRAMI registry. JACC Cardiovasc Interv 11:320–322

    Article  PubMed  Google Scholar 

  15. Baldus S, Kuck KH, Rudolph V et al (2018) Interventionelle Therapie von AV-Klappenerkrankungen - Fokus Mitralklappeninsuffizienz. Kardiologe 2:128–144

    Google Scholar 

  16. de Waha S, Seeburger J, Ender J et al (2016) Deep sedation versus general anesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system. Clin Res Cardiol 105:535–543

    Article  PubMed  CAS  Google Scholar 

  17. Hellhammer K, Afzal S, Tigges R et al (2018) High body mass index is a risk factor for difficult deep sedation in percutaneous mitral valve repair. PLoS One 13:e0190590

    Article  PubMed  PubMed Central  Google Scholar 

  18. de Waha S, Desch S, Eitel I, Thiele H (2017) Response to Prof. Dr. med. Gunther Wiesner, Prof. Dr. med. Peter Tassani-Prell, and Dr. Patrick Mayr: Deep sedation versus general anaesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system. Clin Res Cardiol 106:162–163

    Article  PubMed  Google Scholar 

  19. Ledwoch J, Matic P, Franke J et al (2016) Transcatheter mitral valve repair with the MitraClip((R)) can be performed without general anesthesia and without conscious sedation. Clin Res Cardiol 105:297–306

    Article  PubMed  CAS  Google Scholar 

  20. Altiok E, Becker M, Hamada S et al (2011) Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography. Clin Res Cardiol 100:675–681

    Article  PubMed  Google Scholar 

  21. Paranskaya L, Kische S, Akin I et al (2013) Combined use of rapid pacing and adenosine facilitates catheter based correction of severe bileaflet prolapse with the MitraClip system. Can J Cardiol 29:255.e1–255.e3

    Google Scholar 

  22. Lubos E, Schluter M, Vettorazzi E et al (2014) MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome. JACC Cardiovasc Interv 7:394–402

    Article  PubMed  Google Scholar 

  23. Neuss M, Schau T, Isotani A et al (2017) 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 10:931–939

    Article  PubMed  Google Scholar 

  24. Ruf TF, Heidrich FM, Sveric KM et al (2017) ELMSTREET (Esophageal Lesions during MitraClip uSing TRansEsophageal Echocardiography Trial). EuroIntervention 13:e1444–e1451

    Article  PubMed  Google Scholar 

  25. Blazek S, Lurz P, Mangner N et al (2015) Incidence, characteristics and functional implications of cerebral embolic lesions after the MitraClip procedure. EuroIntervention 10:1195–1203

    Article  PubMed  Google Scholar 

  26. Frerker C, Schluter M, Sanchez OD et al (2016) Cerebral protection during MitraClip implantation: initial experience at 2 centers. JACC Cardiovasc Interv 9:171–179

    Article  PubMed  Google Scholar 

  27. Korber MI, Scherner M, Kuhr K et al (2018) Acute kidney injury following percutaneous edge-to-edge vs. minimally invasive surgical mitral valve repair: incidence, predictors and prognostic value. EuroIntervention 13:1645–1651

    Article  PubMed  Google Scholar 

  28. Korber MI, Silwedel J, Friedrichs K et al (2018) Bleeding complications after percutaneous mitral valve repair with the MitraClip. Am J Cardiol 121:94–99

    Article  PubMed  Google Scholar 

  29. Iliadis C, Lee S, Kuhr K et al (2017) Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review. Clin Res Cardiol 106:1005–1017

    Article  PubMed  Google Scholar 

  30. Schueler R, Ozturk C, Sinning JM et al (2017) Impact of baseline tricuspid regurgitation on long-term clinical outcomes and survival after interventional edge-to-edge repair for mitral regurgitation. Clin Res Cardiol 106:350–358

    Article  PubMed  Google Scholar 

  31. Schwencke C, Bijuklic K, Ouarrak T et al (2017) Impact of cardiac comorbidities on early and 1-year outcome after percutaneous mitral valve interventions: data from the German transcatheter mitral valve interventions (TRAMI) registry. Clin Res Cardiol 106:249–258

    Article  PubMed  Google Scholar 

  32. Zuern CS, Bauer A, Lubos E et al (2015) Influence of non-cardiac comorbidities on outcome after percutaneous mitral valve repair: results from the German transcatheter mitral valve interventions (TRAMI) registry. Clin Res Cardiol 104:1044–1053

    Article  PubMed  Google Scholar 

  33. Ledwoch J, Franke J, Lubos E et al (2018) Prognostic value of preprocedural 6-min walk test in patients undergoing transcatheter mitral valve repair—insights from the German transcatheter mitral valve interventions registry. Clin Res Cardiol 107:241–248

    Article  PubMed  Google Scholar 

  34. Wiebe J, Franke J, Lubos E et al (2014) Percutaneous mitral valve repair with the MitraClip system according to the predicted risk by the logistic EuroSCORE: preliminary results from the German transcatheter mitral valve interventions (TRAMI) registry. Catheter Cardiovasc Interv 84:591–598

    Article  PubMed  Google Scholar 

  35. Lesevic H, Karl M, Braun D et al (2017) Long-term outcomes after MitraClip implantation according to the presence or absence of EVEREST inclusion criteria. Am J Cardiol 119:1255–1261

    Article  PubMed  Google Scholar 

  36. Schafer U, Maisano F, Butter C et al (2016) Impact of preprocedural left ventricular ejection fraction on 1-year outcomes after MitraClip implantation (from the ACCESS-EU phase I, a prospective, multicenter, nonrandomized postapproval study of the MitraClip therapy in Europe). Am J Cardiol 118:873–880

    Article  PubMed  Google Scholar 

  37. Rudolph V, Huntgeburth M, von Bardeleben RS et al (2014) Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy. Eur J Heart Fail 16:1223–1229

    Article  PubMed  Google Scholar 

  38. Neuss M, Schau T, Schoepp M et al (2013) 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 15:786–795

    Article  PubMed  Google Scholar 

  39. Metze C, Matzik AS, Scherner M et al (2017) Impact of frailty on outcomes in patients undergoing percutaneous mitral valve repair. JACC Cardiovasc Interv 10:1920–1929

    Article  PubMed  Google Scholar 

  40. Maisano F, Taramasso M, Nickenig G et al (2016) Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial. Eur Heart J 37:817–825

    Article  PubMed  Google Scholar 

  41. Nickenig G, Hammerstingl C, Schueler R et al (2016) Transcatheter mitral annuloplasty in chronic functional mitral regurgitation: 6-month results with the cardioband percutaneous mitral repair system. JACC Cardiovasc Interv 9:2039–2047

    Article  PubMed  Google Scholar 

  42. Nickenig G, Schueler R, Dager A et al (2016) Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. J Am Coll Cardiol 67:2927–2936

    Article  PubMed  Google Scholar 

  43. Hammerstingl C, Schueler R, Malasa M et al (2016) Transcatheter treatment of severe tricuspid regurgitation with the MitraClip system. Eur Heart J 37:849–853

    Article  PubMed  Google Scholar 

  44. Nickenig G, Kowalski M, Hausleiter J et al (2017) Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge MitraClip technique. Circulation 135:1802–1814

    Article  PubMed  Google Scholar 

  45. Orban M, Besler C, Braun D et al (2018) Six-month outcome after transcatheter edge-to-edge repair of severe tricuspid regurgitation in patients with heart failure. Eur J Heart Fail 20:1055–1062

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik III, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany

    Roman Pfister & Stephan Baldus

Authors
  1. Roman Pfister
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephan Baldus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roman Pfister.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pfister, R., Baldus, S. Atrioventricular valve disease: challenges and achievements in percutaneous treatment. Clin Res Cardiol 107 (Suppl 2), 88–93 (2018). https://doi.org/10.1007/s00392-018-1303-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-018-1303-6

Keywords

Search

Navigation