Complications and management of transcatheter edge-to-edge mitral valve repair_West China Medical Journal

Authors：

CHEN Jiaohua ,  LI Jie , LUO Jianfang

Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P. R. China;

Corresponding author：

LI Jie, Email: leomoku1981@163.com

Keywords：

Mitral regurgitation; transcatheter edge-to-edge mitral valve repair; complications

DOI：

10.7507/1002-0179.202208006

Video：

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Mitral regurgitation has high morbidity and mortality. The application of transcatheter edge-to-edge mitral valve repair (TEER) has provided more options for the management of primary and secondary mitral regurgitation. With the accumulation of operator experience, the improvement of equipment, and the optimization of intraoperative imaging, TEER can be applied to more complex or critically ill patients. The incidence of TEER-related adverse events is low, but some complications that may occur are potentially dangerous. TEER-related complications and their treatment methods are the guarantee of safe and effective operation. This article discusses the main possible complications of TEER and the corresponding management strategies.

Citation： CHEN Jiaohua, LI Jie, LUO Jianfang. Complications and management of transcatheter edge-to-edge mitral valve repair. West China Medical Journal, 2022, 37(9): 1288-1292. doi: 10.7507/1002-0179.202208006 Copy

1.	Bonow RO, O’Gara PT, Adams DH, et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
2.	Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol, 2015, 66(25): 2844-2854.
3.	Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
4.	Panaich SS, Arora S, Badheka A, et al. Procedural trends, outcomes, and readmission rates pre-and post-FDA approval for MitraClip from the National Readmission Database (2013-14). Catheter Cardiovasc Interv, 2018, 91(6): 1171-1181.
5.	Asgar AW, Khairy P. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med, 2011, 365(1): 90, author reply 91.
6.	Puls M, Lubos E, Boekstegers P, et al. One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J, 2016, 37(8): 703-712.
7.	Elbadawi A, Elgendy IY, Mohamed AH, et al. Temporal trends and outcomes of transcatheter mitral valve repair and surgical mitral valve intervention. Cardiovasc Revasc Med, 2020, 21(12): 1560-1566.
8.	Chakravarty T, Makar M, Patel D, et al. Transcatheter edge-to-edge mitral valve repair with the MitraClip G4 system. JACC Cardiovasc Interv, 2020, 13(20): 2402-2414.
9.	Weinmann K, Markovic S, Rottbauer W, et al. First experience with the MitraClip XTR device for extensive mitral valve prolapse (Barlow’s disease). EuroIntervention, 2018, 14(12): e1276-e1277.
10.	Praz F, Braun D, Unterhuber M, et al. Edge-to-edge mitral valve repair with extended clip arms: early experience from a multicenter observational study. JACC Cardiovasc Interv, 2019, 12(14): 1356-1365.
11.	Praz F, Winkel MG, Fam NP. A new age for transcatheter mitral valve repair: the complexity of choice. JACC Cardiovasc Interv, 2020, 13(20): 2415-2417.
12.	Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: an STS/ACC TVT registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
13.	Steppich B, Stegmüller F, Rumpf PM, et al. Vascular complications after percutaneous mitral valve repair and venous access closure using suture or closure device. J Interv Cardiol, 2018, 31(2): 223-229.
14.	Eggebrecht H, Schelle S, Puls M, et al. Risk and outcomes of complications during and after MitraClip implantation: experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry. Catheter Cardiovasc Interv, 2015, 86(4): 728-735.
15.	Schueler R, Öztürk C, Wedekind JA, et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution. JACC Cardiovasc Interv, 2015, 8(3): 450-459.
16.	Toyama K, Rader F, Kar S, et al. Iatrogenic atrial septal defect after percutaneous mitral valve repair with the MitraClip system. Am J Cardiol, 2018, 121(4): 475-479.
17.	Smith T, McGinty P, Bommer W, et al. Prevalence and echocardiographic features of iatrogenic atrial septal defect after catheter-based mitral valve repair with the MitraClip system. Catheter Cardiovasc Interv, 2012, 80(4): 678-685.
18.	Ikenaga H, Hayashi A, Nagaura T, et al. Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip. Heart, 2019, 105(11): 864-872.
19.	Paukovitsch M, Schepperle N, Pott A, et al. Impact of bleeding complications after transcatheter mitral valve repair. Int J Cardiol Heart Vasc, 2021, 32: 100707.
20.	Freitas-Ferraz AB, Rodés-Cabau J, Junquera Vega L, et al. Transesophageal echocardiography complications associated with interventional cardiology procedures. Am Heart J, 2020, 221: 19-28.
21.	Körber MI, Silwedel J, Friedrichs K, et al. Bleeding complications after percutaneous mitral valve repair with the MitraClip. Am J Cardiol, 2018, 121(1): 94-99.
22.	Gheorghe L, Ielasi A, Rensing BJWM, et al. Complications following percutaneous mitral valve repair. Front Cardiovasc Med, 2019, 6: 146.
23.	Barros da Silva P, Sousa JP, Oliveiros B, et al. Stroke after transcatheter edge-to-edge mitral valve repair: a systematic review and meta-analysis. EuroIntervention, 2020, 15(16): 1401-1408.
24.	Spieker M, Hellhammer K, Katsianos S, et al. Effect of acute kidney injury after percutaneous mitral valve repair on outcome. Am J Cardiol, 2018, 122(2): 316-322.
25.	Asmarats L, Rodriguez-Gabella T, Chamandi C, et al. Infective endocarditis following transcatheter edge-to-edge mitral valve repair: a systematic review. Catheter Cardiovasc Interv, 2018, 92(3): 583-591.
26.	Leow K, Isreb C, Brown M. MitraClip-related infective endocarditis in a frail, elderly patient: a case report. Eur Heart J Case Rep, 2020, 4(5): 1-4.
27.	Chhatriwalla AK, Vemulapalli S, Szerlip M, et al. Operator experience and outcomes of transcatheter mitral valve repair in the United States. J Am Coll Cardiol, 2019, 74(24): 2955-2965.
28.	Chhatriwalla AK, Vemulapalli S, Holmes DR Jr, et al. Institutional experience with transcatheter mitral valve repair and clinical outcomes: insights from the TVT registry. JACC Cardiovasc Interv, 2019, 12(14): 1342-1352.
29.	Neuss M, Schau T, Isotani A, et al. Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure. JACC Cardiovasc Interv, 2017, 10(9): 931-939.
30.	Stone GW, Adams DH, Abraham WT, et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: a consensus document from the Mitral Valve Academic Research Consortium. Eur Heart J, 2015, 36(29): 1878-1891.
31.	Kreidel F, Frerker C, Schlüter M, et al. Repeat MitraClip therapy for significant recurrent mitral regurgitation in high surgical risk patients: impact of loss of leaflet insertion. JACC Cardiovasc Interv, 2015, 8(11): 1480-1489.
32.	Schnitzler K, Hell M, Geyer M, et al. Complications following MitraClip implantation. Curr Cardiol Rep, 2021, 23(9): 131.
33.	Nickenig G, Estevez-Loureiro R, Franzen O, et al. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 Pilot European Sentinel Registry. J Am Coll Cardiol, 2014, 64(9): 875-884.
34.	Bilge M, Alsancak Y, Ali S, et al. An extremely rare but possible complication of MitraClip: embolization of clip during follow-up. Anatol J Cardiol, 2016, 16(8): 636-638.
35.	Alozie A, Westphal B, Kische S, et al. Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population. Eur J Cardiothorac Surg, 2014, 46(1): 55-60.
36.	Nagai M, Kurokawa S, Ozaki M, et al. Attachment of a migrated MitraClip to the left ventricular apex: a novel case report. Echocardiography, 2020, 37(1): 139-141.
37.	von Bardeleben RS, Hobohm L, Kreidel F, et al. Incidence and in-hospital safety outcomes of patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip: five-year German national patient sample including 13, 575 implants. EuroIntervention, 2019, 14(17): 1725-1732.
38.	Lisko JC, Greenbaum AB, Guyton RA, et al. Electrosurgical detachment of MitraClips from the anterior mitral leaflet prior to transcatheter mitral valve implantation. JACC Cardiovasc Interv, 2020, 13(20): 2361-2370.

1. Bonow RO, O’Gara PT, Adams DH, et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
2. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol, 2015, 66(25): 2844-2854.
3. Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
4. Panaich SS, Arora S, Badheka A, et al. Procedural trends, outcomes, and readmission rates pre-and post-FDA approval for MitraClip from the National Readmission Database (2013-14). Catheter Cardiovasc Interv, 2018, 91(6): 1171-1181.
5. Asgar AW, Khairy P. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med, 2011, 365(1): 90, author reply 91.
6. Puls M, Lubos E, Boekstegers P, et al. One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J, 2016, 37(8): 703-712.
7. Elbadawi A, Elgendy IY, Mohamed AH, et al. Temporal trends and outcomes of transcatheter mitral valve repair and surgical mitral valve intervention. Cardiovasc Revasc Med, 2020, 21(12): 1560-1566.
8. Chakravarty T, Makar M, Patel D, et al. Transcatheter edge-to-edge mitral valve repair with the MitraClip G4 system. JACC Cardiovasc Interv, 2020, 13(20): 2402-2414.
9. Weinmann K, Markovic S, Rottbauer W, et al. First experience with the MitraClip XTR device for extensive mitral valve prolapse (Barlow’s disease). EuroIntervention, 2018, 14(12): e1276-e1277.
10. Praz F, Braun D, Unterhuber M, et al. Edge-to-edge mitral valve repair with extended clip arms: early experience from a multicenter observational study. JACC Cardiovasc Interv, 2019, 12(14): 1356-1365.
11. Praz F, Winkel MG, Fam NP. A new age for transcatheter mitral valve repair: the complexity of choice. JACC Cardiovasc Interv, 2020, 13(20): 2415-2417.
12. Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: an STS/ACC TVT registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
13. Steppich B, Stegmüller F, Rumpf PM, et al. Vascular complications after percutaneous mitral valve repair and venous access closure using suture or closure device. J Interv Cardiol, 2018, 31(2): 223-229.
14. Eggebrecht H, Schelle S, Puls M, et al. Risk and outcomes of complications during and after MitraClip implantation: experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry. Catheter Cardiovasc Interv, 2015, 86(4): 728-735.
15. Schueler R, Öztürk C, Wedekind JA, et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution. JACC Cardiovasc Interv, 2015, 8(3): 450-459.
16. Toyama K, Rader F, Kar S, et al. Iatrogenic atrial septal defect after percutaneous mitral valve repair with the MitraClip system. Am J Cardiol, 2018, 121(4): 475-479.
17. Smith T, McGinty P, Bommer W, et al. Prevalence and echocardiographic features of iatrogenic atrial septal defect after catheter-based mitral valve repair with the MitraClip system. Catheter Cardiovasc Interv, 2012, 80(4): 678-685.
18. Ikenaga H, Hayashi A, Nagaura T, et al. Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip. Heart, 2019, 105(11): 864-872.
19. Paukovitsch M, Schepperle N, Pott A, et al. Impact of bleeding complications after transcatheter mitral valve repair. Int J Cardiol Heart Vasc, 2021, 32: 100707.
20. Freitas-Ferraz AB, Rodés-Cabau J, Junquera Vega L, et al. Transesophageal echocardiography complications associated with interventional cardiology procedures. Am Heart J, 2020, 221: 19-28.
21. Körber MI, Silwedel J, Friedrichs K, et al. Bleeding complications after percutaneous mitral valve repair with the MitraClip. Am J Cardiol, 2018, 121(1): 94-99.
22. Gheorghe L, Ielasi A, Rensing BJWM, et al. Complications following percutaneous mitral valve repair. Front Cardiovasc Med, 2019, 6: 146.
23. Barros da Silva P, Sousa JP, Oliveiros B, et al. Stroke after transcatheter edge-to-edge mitral valve repair: a systematic review and meta-analysis. EuroIntervention, 2020, 15(16): 1401-1408.
24. Spieker M, Hellhammer K, Katsianos S, et al. Effect of acute kidney injury after percutaneous mitral valve repair on outcome. Am J Cardiol, 2018, 122(2): 316-322.
25. Asmarats L, Rodriguez-Gabella T, Chamandi C, et al. Infective endocarditis following transcatheter edge-to-edge mitral valve repair: a systematic review. Catheter Cardiovasc Interv, 2018, 92(3): 583-591.
26. Leow K, Isreb C, Brown M. MitraClip-related infective endocarditis in a frail, elderly patient: a case report. Eur Heart J Case Rep, 2020, 4(5): 1-4.
27. Chhatriwalla AK, Vemulapalli S, Szerlip M, et al. Operator experience and outcomes of transcatheter mitral valve repair in the United States. J Am Coll Cardiol, 2019, 74(24): 2955-2965.
28. Chhatriwalla AK, Vemulapalli S, Holmes DR Jr, et al. Institutional experience with transcatheter mitral valve repair and clinical outcomes: insights from the TVT registry. JACC Cardiovasc Interv, 2019, 12(14): 1342-1352.
29. Neuss M, Schau T, Isotani A, et al. Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure. JACC Cardiovasc Interv, 2017, 10(9): 931-939.
30. Stone GW, Adams DH, Abraham WT, et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: a consensus document from the Mitral Valve Academic Research Consortium. Eur Heart J, 2015, 36(29): 1878-1891.
31. Kreidel F, Frerker C, Schlüter M, et al. Repeat MitraClip therapy for significant recurrent mitral regurgitation in high surgical risk patients: impact of loss of leaflet insertion. JACC Cardiovasc Interv, 2015, 8(11): 1480-1489.
32. Schnitzler K, Hell M, Geyer M, et al. Complications following MitraClip implantation. Curr Cardiol Rep, 2021, 23(9): 131.
33. Nickenig G, Estevez-Loureiro R, Franzen O, et al. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 Pilot European Sentinel Registry. J Am Coll Cardiol, 2014, 64(9): 875-884.
34. Bilge M, Alsancak Y, Ali S, et al. An extremely rare but possible complication of MitraClip: embolization of clip during follow-up. Anatol J Cardiol, 2016, 16(8): 636-638.
35. Alozie A, Westphal B, Kische S, et al. Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population. Eur J Cardiothorac Surg, 2014, 46(1): 55-60.
36. Nagai M, Kurokawa S, Ozaki M, et al. Attachment of a migrated MitraClip to the left ventricular apex: a novel case report. Echocardiography, 2020, 37(1): 139-141.
37. von Bardeleben RS, Hobohm L, Kreidel F, et al. Incidence and in-hospital safety outcomes of patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip: five-year German national patient sample including 13, 575 implants. EuroIntervention, 2019, 14(17): 1725-1732.
38. Lisko JC, Greenbaum AB, Guyton RA, et al. Electrosurgical detachment of MitraClips from the anterior mitral leaflet prior to transcatheter mitral valve implantation. JACC Cardiovasc Interv, 2020, 13(20): 2361-2370.

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