Percutaneous Edge-to-Edge Mitral Valve Repair Using the New MitraClip XTR System

Transcatheter Mitral Valve Repair with MitraClip for Severe Mitral Regurgitation and Cardiogenic Shock During the COVID-19 Pandemic

Transcatheter mitral valve repair with MitraClip (Abbott) is largely an elective procedure. The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed challenges to health care systems; in many cases elective interventions have been curtailed. Patients with severe mitral regurgitation (MR) and cardiogenic shock are high-risk surgical candidates and at risk of a poor outcome without intervention. The American College of Cardiology (ACC) and the Society of Coronary Angiography and Interventions (SCAI) recently proposed joint guidance on triage of structural heart disease (SHD) interventions during the COVID-19 pandemic. We present two illustrative cases of severe MR and cardiogenic shock that were successfully treated with MitraClip amidst the COVID-19 pandemic with good outcomes at short term follow-up.

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COVID-19 has strained health care systems worldwide, and elective structural heart interventions have been curtailed

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Patients with severe mitral regurgitation (MR) and cardiogenic shock are high surgical risk and require timely intervention

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We highlight effective triage of mitral interventions during the pandemic in accordance to the SCAI/ACC consensus

[Edge-to-edge repair : What has changed compared to the position paper in 2013?]

This short review article aims to explain the changes in the treatment strategies of interventional care designed to treat secondary mitral valve regurgitation with edge-to-edge repair in comparison to the position paper published in 2013 by the German Society of Cardiology and the German Society of Thoracic and Cardiovascular Surgery. To this end the current data situation with respect to the European Society of Cardiology (ESC) guidelines from 2017, the intraprocedural assessment of mitral valve regurgitation and new technical developments are discussed.

Ischemic Mitral Regurgitation: Current Understanding and Surgical Options

Secondary, or functional, mitral regurgitation (MR) occurs with impaired coaptation of structurally normal valve leaflets due to abnormal structure and/or function of the left ventricle (LV). A leading cause of functional mitral regurgitation is ischemic cardiomyopathy, resulting in left ventricular dysfunction and subsequent congestive heart failure (CHF) and ischemic mitral regurgitation (IMR). The value of surgical or transcatheter correction of IMR remains controversial, since the underlying pathology of IMR is attributed to a dysfunctional left ventricle. However, even mild IMR has been shown to be harmful to CHF patients, as IMR is both a surrogate of advanced CHF and an independent contributor to CHF morbidity and mortality. While observational and randomized studies have examined surgical treatment of IMR with conflicting outcomes, additional well-designed randomized controlled trials should be performed to further clarify the optimal treatment for IMR. Additionally, close attention should be paid to the quality of interventions performed, as durable reduction in IMR provides the best hope of a positive clinical outcome. This review focuses on the pathophysiology of IMR, current evidence regarding surgical and transcatheter interventions, and future directions in management of IMR.