Author + information
- Received February 1, 2019
- Revision received March 19, 2019
- Accepted March 22, 2019
- Published online July 15, 2019.
- Fabien Praz, MDa,∗,
- Daniel Braun, MDb,∗,
- Matthias Unterhuber, MDc,
- Alessandro Spirito, MDa,
- Mathias Orban, MDb,
- Nicolas Brugger, MDa,
- Isabel Brinkmann, MDb,
- Karin Spring, RNa,
- Aris Moschovitis, MDa,
- Michael Nabauer, MDb,
- Stephan Blazek, MDc,
- Thomas Pilgrim, MDa,
- Holger Thiele, MDc,
- Philipp Lurz, MDc,
- Jörg Hausleiter, MDb,†∗ ( and )
- Stephan Windecker, MDa,†
- aDepartment of Cardiology, University Hospital, University of Bern, Bern, Switzerland
- bMedizinische Klinik und Poliklinik I, Ludwig Maximilians Universität München, München, Germany
- cDepartment of Cardiology, Heart Center Leipzig–University Hospital, Leipzig, Germany
- ↵∗Address for correspondence:
Prof. Jörg Hausleiter, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistrasse 15, D-81377 München, Germany.
Objectives The aim of this study was to investigate the technical success and efficacy of mitral valve edge-to-edge repair using extended clip arms.
Background A new iteration of the MitraClip system, the MitraClip XTR, was introduced in 2018 with the aim of addressing technical limitations observed with previous versions.
Methods Patients having received at least 1 new implant for the treatment of symptomatic mitral regurgitation (MR) were eligible for this study.
Results Among the 107 patients (mean age 76 ± 9 years, 69% men) included in this study, the etiology of MR was balanced, with one-half (n = 53 [50%]) classified as secondary and the remaining 54 patients having either primary (n = 40 [37%]) or mixed (n = 14 [13%]) disease. The mean number of devices implanted was 1.5 ± 0.6. Multiple device implantation was required in 46 patients (43%). Single-leaflet device attachment occurred in 4 patients and leaflet injury in 2 additional patients, requiring surgical conversion in 4 patients. Among the 102 patients discharged alive without mitral valve surgery, 95 (93%) had MR ≤2+ and 79 (77%) had MR ≤1+. The mean transmitral gradient increased from 1.9 ± 1.0 mm Hg at baseline to 3.5 ± 1.8 mm Hg at discharge (p < 0.001).
Conclusions Technical success with the new mitral valve repair system with extended clip arm was achieved in 93% of the patients. MR ≤2+ was obtained in 95 patients (93%) and MR ≤1+ in 79 (77%). The main reasons for procedural failure were acute single-leaflet device attachment associated with leaflet damage or isolated leaflet injury and often required surgical correction.
↵∗ Drs. Praz and Braun contributed equally to this work and are joint first authors.
↵† Drs. Hausleiter and Windecker contributed equally to this work and are joint senior authors.
Dr. Praz has served as a consultant for Edwards Lifesciences. Dr. Braun has received speaking honoraria from Abbott Vascular. Dr. Nabauer has received speaking honoraria from Abbott Vascular. Dr. Pilgrim has received research grants to his institution from Edwards Lifesciences, Symetis/Boston Scientific, and Biotronik; and has received speaking fees from Boston Scientific and Biotronik. Dr. Lurz is a consultant to and has received speaking honoraria from Abbott. Dr. Hausleiter has received speaking honoraria from Abbott Vascular and Edwards Lifesciences. Dr. Windecker has received research grants to his institution from Abbott, Amgen, Boston Scientific, Biotronik, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Raj Makkar, MD, served as Guest Editor for this paper.
- Received February 1, 2019.
- Revision received March 19, 2019.
- Accepted March 22, 2019.
- 2019 American College of Cardiology Foundation
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