Author + information
- Received March 15, 2018
- Revision received March 28, 2018
- Accepted April 4, 2018
- Published online June 18, 2018.
- Rezo Jorbenadze, MDa,
- Juergen Schreieck, MDa,
- Carola Barthelb,
- Peter Seizer, MDa,
- Christian Schlensak, MDc,
- Meinrad Gawaz, MDa,
- Johannes Patzelt, MDa and
- Harald F. Langer, MDa,∗ ()
- aUniversity Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany
- bAbbott Vascular, Wiesbaden, Germany
- cUniversity Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, Tuebingen, Germany
- ↵∗Address for correspondence:
Dr. Harald F. Langer, Eberhard Karls University Tuebingen, Department of Cardiology and Cardiovascular Medicine, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany.
A 69-year-old man was admitted to our hospital with progressive dyspnea. Transesophageal echocardiography revealed underlying severe mitral regurgitation (MR) with a mixed genesis of MR (Figures 1A and 1B). Our interdisciplinary heart team recommended interventional mitral valve repair because of the profoundly reduced left ventricular function (left ventricular ejection fraction 25%) and severe comorbidities in this patient.
The percutaneous edge-to-edge mitral valve repair (PMVR) procedure was performed using a new-generation MitraClip, the XTR system (Abbott Vascular, Santa Clara, California). In comparison with the NT clip, this new system has longer clip arms (an additional 3 mm of length for each arm) and longer grippers with 2 additional rows of frictional elements (Figures 1C and 1D), facilitating grasping of both mitral valve leaflets. Intraprocedural transesophageal echocardiography showed a significant reduction of MR from severe to mild after deployment of 1 XTR clip in the central mitral valve segments (A2/P2) (mitral valve area and mean transmitral gradient pre-intervention 4.5 cm2 and 2 mm Hg, post-intervention 2.2 cm2 and 3 mm Hg, respectively) (Figures 1E to 1I).
PMVR is accepted as an effective option for patients with severe MR who are not eligible for conventional heart surgery (1,2). Currently the MitraClip NT system is in use. Because of its increased span and improved grip, the new XTR clip may facilitate PMVR procedures, particularly in complex cases, or even make previously unpromising cases possible. Future trials will have to scrutinize whether the new system can improve mitral valve leaflet coaptation and anteroposterior ring approximation. Beyond PMVR, the XTR clip could be a promising option for percutaneous tricuspid valve repair (3,4).
Our first experience with this new clip system is encouraging and supports the initiation of future clinical studies.
Written informed consent was obtained from the patient for publication of this case and any accompanying images.
Dr. Langer was reimbursed for training courses in the PMVR procedure by Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 15, 2018.
- Revision received March 28, 2018.
- Accepted April 4, 2018.
- 2018 American College of Cardiology Foundation
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