Shrivastava Shitij, Shrivastava Shashwat, Allu Sai Vishnu Vardhan, Schmidt Patrik, Mohyeldin Moiud, Qasim Abeer
Medicine, BronxCare Health System, New York, USA.
Cardiothoracic Surgery, New York University, New York, USA.
Cureus. 2024 Feb 24;16(2):e54805. doi: 10.7759/cureus.54805. eCollection 2024 Feb.
This comprehensive review explores the evolution and clinical impact of MitraClip intervention in the management of mitral regurgitation. Mitral regurgitation results from dysfunction in the mitral valve (MV) apparatus. The MitraClip Clip Delivery System was approved by the Food and Drug Administration (FDA) in 2013. The discussion delves into the procedural foundation of MitraClip intervention, primarily based on Alfieri's technique of edge-to-edge leaflet approximation. As highlighted by key clinical trials, including Endovascular Valve Edge-to-Edge Repair (EVEREST) II Trial, Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) Trial, and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation (MITRA-FR) trial, the efficacy and safety of MitraClip were evaluated in comparison to surgical interventions and guideline-directed medical therapy. Notably, the COAPT demonstrated significant benefits in reducing all-cause mortality and heart failure hospitalization, while the MITRA-FR presented contrasting results, emphasizing the importance of patient selection. An analysis of the EVEREST II trial underscores MitraClip's potential to achieve comparable outcomes to surgical intervention, emphasizing its role in reducing mitral regurgitation and improving clinical status. However, limitations and complications, such as device-related issues and the potential impact on future MV surgery, are discussed. The study also explores the evolving landscape of MV interventions, reflecting advancements and the growing acceptance of MitraClip. In conclusion, the MitraClip device represents a significant advancement in the treatment of mitral regurgitation. The data presented highlights its promising results in terms of reduced hospitalization rates, improved in-hospital mortality, and enhanced quality of life for patients. However, challenges remain, and careful consideration of patient selection and underlying pathology is crucial in determining the optimal treatment approach. Ongoing research and clinical experience will continue to refine our understanding of MitraClip's role in the evolving landscape of MV interventions.
本综述探讨了MitraClip干预在二尖瓣反流管理中的演变及其临床影响。二尖瓣反流是由二尖瓣（MV）装置功能障碍引起的。MitraClip夹合输送系统于2013年获得美国食品药品监督管理局（FDA）批准。讨论深入探讨了MitraClip干预的程序基础，主要基于阿尔菲耶里的缘对缘瓣叶贴合技术。包括血管内瓣膜缘对缘修复（EVEREST）II试验、MitraClip经皮治疗心力衰竭合并功能性二尖瓣反流患者的心血管结局评估（COAPT）试验以及使用MitraClip装置经皮修复严重功能性/继发性二尖瓣反流（MITRA-FR）试验在内的关键临床试验表明，与手术干预和指南指导的药物治疗相比，对MitraClip的疗效和安全性进行了评估。值得注意的是，COAPT试验显示在降低全因死亡率和心力衰竭住院率方面有显著益处，而MITRA-FR试验则呈现出相反的结果，强调了患者选择的重要性。对EVEREST II试验的分析强调了MitraClip与手术干预取得可比结果的潜力，突出了其在减少二尖瓣反流和改善临床状况方面的作用。然而，也讨论了局限性和并发症，如与器械相关的问题以及对未来MV手术的潜在影响。该研究还探讨了MV干预的不断变化的格局，反映了MitraClip的进展和越来越广泛的接受度。总之，MitraClip装置代表了二尖瓣反流治疗的重大进展。所呈现的数据突出了其在降低住院率、改善院内死亡率以及提高患者生活质量方面的 promising results。然而，挑战仍然存在，在确定最佳治疗方法时，仔细考虑患者选择和潜在病理情况至关重要。正在进行的研究和临床经验将继续完善我们对MitraClip在不断演变的MV干预格局中作用的理解。
