ObjectiveTo utilize a rapid health technology assessment to evaluate the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe mitral regurgitation (MR). MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, CBM and the CRD databases were electronically searched to collect clinical evidence and economic evaluations on the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe MR from inception to May 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, descriptive analyses and data summaries were performed. ResultsA total of 33 studies, involving 4 HTA reports, 3 RCTs, 16 systematic reviews or meta-analyses, and 10 economic evaluations were included. In the evidence comparing MitraClip and surgery, most of the literature showed that the MitraClip group had higher postoperative residual MR, fewer blood transfusion events, and fewer hospital days. We found no significant treatment effects on 30-day adverse events and mortality, and the 1-year and above survival rate. In the evidence of MitraClip versus medical therapy alone, all included studies showed that MitraClip benefited mid-term and long-term survival and reduced the incidence of subsequent cardiac hospitalizations. Economic evaluations showed that the clinical benefits were cost-effective in the setting of their health service systems. ConclusionThe available high-grade clinical evidence shows that MitraClip is effective and safe to some extent, and has cost-effectiveness compared with traditional treatment in other countries. However, the real-world effectiveness and cost-effectiveness of the MitraClip need to be tested in the Chinese population and health-care setting.
Echocardiography is an important imaging technique in mithal valve transcatheter edge-to-edge repair (TEER). During the operation, mitral leaflets capture and clamping have the highest requirements for ultrasound image quality and should be performed under the guidance of high-quality commissural view. However, standard commissural view cannot be obtained in some patients due to cardiac enlargement, transposition or limited esophageal acoustic window. In this condition, the optimal view can be obtained by Multivue technology. This paper reports a male patient aged 67 years with successful mitral valve TEER under the real-time guidance of Multivue technology, and summarizes the key points of this technology.
Atrial functional mitral regurgitation (AFMR) is characterized by left atrial enlargement, without left ventricular dilation or systolic dysfunction, and with structurally normal leaflet tissue. It predominantly occurs in patients with atrial fibrillation and heart failure with preserved ejection fraction. The complex pathophysiological mechanisms involve mitral annular dilation, atriogenic leaflet tethering, and inadequate leaflet adaptation. Currently, standardized management protocols for AFMR remain lacking. Common approaches include pharmacotherapy, rhythm control, and surgical or percutaneous interventions, all requiring individualized therapeutic strategy based on etiology and clinical characteristics. This review discusses recent advances in the pathogenesis and treatment of AFMR, aiming to provide valuable insights for clinical practice and future research.
Mitral regurgitation is the most common heart valvular disease at present. In the past, mitral regurgitation was mainly treated by surgical mitral valve repair or replacement. However, with the progress of transcatheter interventional techniques and instruments in recent years, transcatheter mitral valve interventional therapy has gradually shown its advantages and benefited patients. The purpose of this article is to review the progress of transcatheter mitral valve intervention in this year, and to provide prospects for the future of transcatheter mitral valve treatment.
For patients with moderate-to-severe functional mitral regurgitation (FMR) who continue to experience heart failure symptoms despite optimized medical and device therapy, transcatheter mitral valve edge-to-edge repair (TEER) is increasingly becoming a reliable treatment option. With the continuous research and development and improvement of TEER-related devices, there are currently dozens of domestically developed TEER devices undergoing clinical trials in China. In this study, we report the first case of a patient with severe FMR treated with the X-Clip® TEER system. The patient, a 60-year-old male, suffered FMR attributed to dilated cardiomyopathy. Preoperative transthoracic echocardiography showed severe mitral regurgitation (4+). He underwent percutaneous repair using the X-Clip® system, and immediate postoperative ultrasound showed mild mitral regurgitation. At the 1-month follow-up, the patient’s symptoms and New York Heart Association (NYHA) functional class improved, and a follow-up transthoracic echocardiogram showed mild mitral regurgitation (1+).
Transcatheter mitral valve edge-to-edge repair (TEER) has become an essential treatment option for patients with severe mitral regurgitation at high or prohibitive surgical risk. However, the surgical devices and procedural steps of the surgery are intricate, and there is currently a lack of standardized TEER procedures in China. Based on existing evidence and the accumulated experience in clinical practice, this article briefly introduces the definition, indications, contraindications, and surgical devices of TEER. It also provides a systematic and detailed elaboration on the procedural steps, key technical points, complications, and their management measures, offering guidance for the standardized implementation and widespread adoption of TEER in clinical practice in China.
Mitral regurgitation is one of the most common valvular heart diseases, with functional mitral regurgitation being the predominant type. Ventricular functional mitral regurgitation (VFMR) occurs due to impaired left ventricular systolic function combined with left ventricular dilation, leading to mitral annular enlargement and papillary muscle displacement, which cause relative tethering of the mitral leaflets despite structurally normal valve apparatus. Patients with VFMR often present with severe heart failure, face high surgical risks, and have a poor prognosis. In recent years, mitral valve transcatheter edge-to-edge repair (TEER) has emerged as a well-established interventional technique, offering a new treatment option for VFMR patients and significantly improving clinical outcomes. This review focuses on the advances in the pathogenesis, epidemiological characteristics, diagnosis, and management of VFMR, particularly the application and efficacy-influencing factors of TEER.
ObjectiveTo explore the effect and safety of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) with mitral regurgitation (MR) through right mini-thoracotomy.MethodsFrom January 2008 to June 2018, 54 patients with HOCM and moderate-to-severe MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy, including 31 males and 23 females, with an average age of 47.1±12.6 years. All patients had systolic anterior motion (SAM) phenomenon. Preoperative left ventricular outflow tract pressure gradient (LVOTPG) was 93.6±32.8 mm Hg, interventricular septum thickness (IVST) was 24.8±2.8 mm.ResultsSurgeries in all patients were completed successfully. No early death or interventricular septal perforation occurred. One (1.9%) patient received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG (18.1±6.2 mm Hg) and IVST (14.5±2.1 mm) were significantly decreased compared with the preoperative values (P<0.05). No MR or SAM was observed in all patients. The follow-up time was 6-132 months, and during this period, no death, MR or SAM occurred. The average LVOTPG was 19.4±5.7 mm Hg, and the average IVST was 14.2±1.5 mm.ConclusionMorrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy is a safe and effective method for treatment of HOCM with moderate-to-severe MR.
Transcatheter edge-to-edge repair (TEER) originated from surgical edge-to-edge repair. MitraClip is the first mature TEER device, and the TEER based on MitraClip is far ahead of many transcatheter mitral valve repair (TMVr) technologies in terms of safety, effectiveness and popularity, so it is named separately in the latest guidelines. The TEER has the following advantages: consistent with basic medical principles, few implants, precise target, less invasive and repeatable. However, there are also some shortcomings, such as the relatively complex design of transfemoral device, target single and relatively narrow indications. At present, the main clinical data of TEER are mainly from the clinical practice of MitraClip. Based on the three-year outcomes of COAPT study, both 2020 ACC/AHA guideline and 2020 ACC expert consensus decision pathway on the management of mitral regurgitation recommend in patients with chronic heart failure with left ventricular dysfunction and severe mitral regurgitation in nonresponders to medicine treatment. Edward's PASCAL, another TEER device, has two models. Among the domestic TEER devices, the ValveClamp of Hanyu medical technology has many distinct advantages, such as simple operation, large clamping area, high clamping efficiency and no need of X-ray. DragonFly, another domestic TEER device, has also completed its feasibility study. There are five trends of TEER in the future: further expansion of indications, combination with other interventional techniques, repeatable operations, transcatheter mitral valve replacement after TEER, and continuous improvement and innovation of equipment.
Transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) is known as M-TEER. Its strengths include: precise targets and fewer implants; simple and clear principles for catheterization; originating from dependable medical concepts and broad applicability. Furthermore, TEER offers advantages in real-time hemodynamic and effectiveness measurement throughout the procedure over surgical edge-to-edge repair (SEER). When it comes to patients with degenerative mitral regurgitation , M-TEER should aim to deliver more optimum procedural outcomes. In functional mitral regurgitation, a modest transvalvular gradients or moderate residual shunt can be tolerated with M-TEER, which reduces the risk of problems and has no bearing on the patient's prognosis.