Guidelines indicate surgical intervention for patients with symptomatic severe mitral regurgitation or signs of left ventricular dilatation or dysfunction. However, many patients do not receive surgery because of age or comorbidities, and have poor outcomes with conservative therapy. Transcatheter mitral repair with MitraClip (Abbott Vascular, IL, USA) has recently emerged as a viable treatment option for high-risk patients with heart failure. This article will review current evidence supporting the use of MitraClip across the spectrum of patient risk and discuss future directions for this technology.
Both randomized and registry studies have demonstrated the efficacy and safety of MitraClip for mitral regurgitation reduction, with significant improvements in functional class and reductions in heart failure hospitalizations. With increasing global experience, a broader scope of patients and diseases can now be successfully treated, ranging from patients with failed surgical annuloplasty rings to those in cardiogenic shock. Ongoing randomized trials will further define the role of MitraClip in the management of heart failure patients with secondary mitral regurgitation.
MitraClip is a useful therapeutic tool for nonsurgical patients with advanced heart failure and severe mitral regurgitation. Further developments in device design and procedural technique will continue to expand the range of patients who can be treated, with a goal of reducing heart failure hospitalizations and improving quality of life.
aDivision of Cardiology, St Michael's Hospital
bDivision of Cardiology, Toronto General Hospital, University Health Network
cDivision of Cardiac Surgery, Keenan Research Centre for Biomedical Science
dLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
Correspondence to Neil P. Fam, MD, MSc, FRCPC, Division of Cardiology, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada. Tel: +1 416 864 5466; fax: +1 416 864 5914; e-mail: email@example.com