MitraClip XTR for Percutaneous Mitral Valve Repair

Study Questions:

What is the feasibility of using a new-generation MitraClip, the XTR system for percutaneous edge-to-edge mitral valve repair (PMVR) procedure?

Methods:

The investigators reported on a 69-year-old man, who was admitted to their hospital with progressive dyspnea. Transesophageal echocardiography revealed underlying severe mitral regurgitation (MR). The 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. PMVR was performed using a new-generation MitraClip, the XTR system. 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 two additional rows of frictional elements, facilitating grasping of both mitral valve leaflets.

Results:

Intraprocedural transesophageal echocardiography showed a significant reduction of MR from severe to mild after deployment of one XTR clip in the central mitral valve segments (A2/P2) (mitral valve area and mean transmitral gradient preintervention 4.5 cm2 and 2 mm Hg, post-intervention 2.2 cm2 and 3 mm Hg, respectively).

Conclusions:

The authors concluded that initial experience with this new clip system is encouraging and supports the initiation of future clinical studies.

Perspective:

PMVR is currently accepted as an effective option for patients with severe MR who are not eligible for conventional heart surgery. The MitraClip NT system is in clinical use at this time. Because of its increased span and improved grip, the new XTR clip may facilitate PMVR procedures, particularly in complex cases, or possibly make previously unattractive cases feasible. Future prospective trials are needed to assess the efficacy/safety and whether the new system can improve mitral valve leaflet coaptation and anteroposterior ring approximation. Beyond PMVR, the XTR clip may be a promising option for percutaneous tricuspid valve repair, but needs further study.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Cardiac Surgical Procedures, Cardiology Interventions, Comorbidity, Diagnostic Imaging, Dyspnea, Echocardiography, Transesophageal, Heart Valve Diseases, Mitral Valve Insufficiency, Transcatheter Aortic Valve Replacement, Tricuspid Valve Insufficiency, Ventricular Function, Left


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