Clinical pathway for transcatheter mitral valve edge-to-edge repair in China (abbreviated version 2022)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 WU Yongjian ¹ ,  LIN Yixian ² ,  ZHOU Daxin ³ ,  SONG Guangyuan ⁴ , Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association , Asia Pacific Structural Heart Disease Club

1. National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Asian Heart Disease Center, Canossa Hospital, Hong Kong, P. R. China;
3. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;
4. Department of Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029,P. R. China;

Corresponding author：

WU Yongjian, Email: yongjianwu_nccd@163.com; LIN Yixian, Email: yylam@me.com; ZHOU Daxin, Email: zhou.daxin@zs-hospital.sh.cn; SONG Guangyuan, Email: songgy_anzhen@VIP.163.com

Keywords：

Transcatheter mitral valve edge-to-edge repair; imaging; procedure; perioperative management; rehabilitation

DOI：

10.7507/1007-4848.202301028

Video：

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Abstract Full text Figures/Tables Video References Cited by

Transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment opinion for patients with severe mitral regurgitation (MR) at high risk for surgery. The devices and procedural techniques of TEER are complex and require excellent team cooperation. However, there is still a lack of standardized clinical pathways in China. Based on the latest evidence, the expert group wrote this clinical pathway to guide and optimize TEER therapy in clinical practice. It demonstrates the following key issues of clinical concern: (1) TEER team building; (2) preoperative clinical evaluation of TEER patients; (3) imaging assessment before TEER procedure; (4) standardized procedures for TEER; (5) TEER for complex MR; (6) the standard process of perioperative comprehensive management; and (7) full life-cycle rehabilitation and follow-up. This clinical pathway might be helpful to facilitate the standardized development of TEER therapy and application, and promote the improvement of management and life quality for patients with MR.

Citation： WU Yongjian, LIN Yixian, ZHOU Daxin, SONG Guangyuan, Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association, Asia Pacific Structural Heart Disease Club. Clinical pathway for transcatheter mitral valve edge-to-edge repair in China (abbreviated version 2022). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 333-343. doi: 10.7507/1007-4848.202301028 Copy

1.	潘文志, 周达新, 葛均波. 中国二尖瓣反流患者人群数量的估测. 中国胸心血管外科临床杂志, 2021, 28(5): 495-498.
2.	聂静雨, 王增武, 张林峰, 等. 35岁及以上人群二尖瓣反流现状及其影响因素研究. 中国循环杂志, 2017, 5(32): 475-479.
3.	Xu H, Liu Q, Cao K, et al. Distribution, characteristics, and management of older patients with valvular heart disease in China: China-DVD study. JACC Asia, 2022, 2(3): 354-365.
4.	Condado JA, Acquatella H, Rodriguez L, et al. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv, 2006, 67(2): 323-325.
5.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
6.	Writing Committee, Otto CM, Nishimura RA, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
7.	中华医学会心血管病学分会. 经导管二尖瓣缘对缘修复术的中国专家共识. 中华心血管病杂志, 2022, 50(9): 853-863.
8.	亚太心脏病学会专家组. 经导管缘对缘技术(MitraClip)治疗二尖瓣反流—亚太心脏病学会(APSC)专家共识. 中国循环杂志, 2022, 37(1): 4-11.
9.	Packer M, Grayburn PA. New evidence supporting a novel conceptual framework for distinguishing proportionate and disproportionate functional mitral regurgitation. JAMA Cardiol, 2020, 5(4): 469-475.
10.	科雨彤, 卢志楠, 吴文辉, 等. 3+ 级以上二尖瓣反流患者的解剖分型及危险分层评估:基于超声核心实验室的初步研究结果. 中国胸心血管外科临床杂志, 2023, 30(2): 205-213.
11.	Wunderlich NC, Beigel R, Ho SY, et al. Imaging for mitral interventions: Methods and efficacy. JACC Cardiovasc Imaging, 2018, 11(6): 872-901.
12.	Bax JJ, Debonnaire P, Lancellotti P, et al. Transcatheter Interventions for mitral regurgitation: Multimodality imaging for patient selection and procedural guidance. JACC Cardiovasc Imaging, 2019, 12(10): 2029-2048.
13.	Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
14.	中国医师协会超声分会超声心动图专业委员会, 中华医学会超声医学分会超声心动图学组, 中华医学会心血管病分会结构性心脏病学组, 等. 二尖瓣反流介入治疗的超声心动图评价中国专家共识. 中国介入心脏病学杂志, 2019, 27(1): 6-12.
15.	Lim DS, Herrmann HC, Grayburn P et al. Consensus document on non-suitability for transcatheter mitral valve repair by edge-to-edge therapy. Structural Heart, 2021, 5(3): 227-233.
16.	Melillo F, Fisicaro A, Stella S, et al. Systematic fluoroscopic-echocardiographic fusion imaging protocol for transcatheter edge-to-edge mitral valve repair intraprocedural monitoring. J Am Soc Echocardiogr, 2021, 34(6): 604-613.
17.	Ge Z, Pan C, Li W, et al. Real-time monitoring and step-by-step guidance for transapical mitral valve edge-to-edge repair using transesophageal echocardiography. J Interv Cardiol, 2021, 2021: 6659261.
18.	Patzelt J, Zhang Y, Seizer P, et al. Effects of mechanical ventilation on heart geometry and mitral valve leaflet coaptation during percutaneous edge-to-edge mitral valve repair. JACC Cardiovasc Interv, 2016, 9(2): 151-159.
19.	Borgia F, Di Mario C, Franzen O. Adenosine-induced asystole to facilitate MitraClip placement in a patient with adverse mitral valve morphology. Heart, 2011, 97(10): 864.
20.	Gavazzoni M, Taramasso M, Zuber M, et al. Conceiving MitraClip as a tool: Percutaneous edge-to-edge repair in complex mitral valve anatomies. Eur Heart J Cardiovasc Imaging, 2020, 21(10): 1059-1067.
21.	Singh GD, Smith TW, Rogers JH. Multi-MitraClip therapy for severe degenerative mitral regurgitation: "Anchor" technique for extremely flail segments. Catheter Cardiovasc Interv, 2015, 86(2): 339-346.
22.	Taramasso M, Maisano F. Challenging mitral clefts with MitraClip: The convergent clips strategy. EuroIntervention, 2016, 12(8): e1071.
23.	Cheng R, Kar S, Siegel RJ, et al. Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve repair. Catheter Cardiovasc Interv, 2019, 93(6): 1161-1164.
24.	Sannino A, Grayburn PA. Mitral regurgitation in patients with severe aortic stenosis: Diagnosis and management. Heart, 2018, 104(1): 16-22.
25.	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.
26.	Guyatt GH, Akl EA, Crowther M, et al. Introduction to the ninth edition: Antithrombotic therapy and prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): 48S-52S.
27.	Feldman T, Foster E, Glower DD, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med, 2011, 364(15): 1395-1406.
28.	Waechter C, Ausbuettel F, Chatzis G, et al. Antithrombotic treatment and its association with outcome in a multicenter cohort of transcatheter edge-to-edge mitral valve repair patients. J Cardiovasc Dev Dis, 2022, 9(11): 366.
29.	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.
30.	Gheorghe L, Ielasi A, Rensing BJWM, et al. Complications following percutaneous mitral valve repair. Front Cardiovasc Med, 2019, 6: 146.
31.	Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve interventions in the real world: Early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol, 2013, 62(12): 1052-1061.
32.	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.
33.	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.
34.	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.
35.	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.
36.	Paukovitsch M, Schneider LM, Reichart C, et al. Prevalence of iatrogenic atrial septal defects (iASD) after mitral valve (MV) transcatheter edge-to-edge repair (TEER) in the long-term follow-up. Open Heart, 2021, 8(2): e001732.
37.	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.
38.	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.

1. 潘文志, 周达新, 葛均波. 中国二尖瓣反流患者人群数量的估测. 中国胸心血管外科临床杂志, 2021, 28(5): 495-498.
2. 聂静雨, 王增武, 张林峰, 等. 35岁及以上人群二尖瓣反流现状及其影响因素研究. 中国循环杂志, 2017, 5(32): 475-479.
3. Xu H, Liu Q, Cao K, et al. Distribution, characteristics, and management of older patients with valvular heart disease in China: China-DVD study. JACC Asia, 2022, 2(3): 354-365.
4. Condado JA, Acquatella H, Rodriguez L, et al. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv, 2006, 67(2): 323-325.
5. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
6. Writing Committee, Otto CM, Nishimura RA, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
7. 中华医学会心血管病学分会. 经导管二尖瓣缘对缘修复术的中国专家共识. 中华心血管病杂志, 2022, 50(9): 853-863.
8. 亚太心脏病学会专家组. 经导管缘对缘技术(MitraClip)治疗二尖瓣反流—亚太心脏病学会(APSC)专家共识. 中国循环杂志, 2022, 37(1): 4-11.
9. Packer M, Grayburn PA. New evidence supporting a novel conceptual framework for distinguishing proportionate and disproportionate functional mitral regurgitation. JAMA Cardiol, 2020, 5(4): 469-475.
10. 科雨彤, 卢志楠, 吴文辉, 等. 3+ 级以上二尖瓣反流患者的解剖分型及危险分层评估:基于超声核心实验室的初步研究结果. 中国胸心血管外科临床杂志, 2023, 30(2): 205-213.
11. Wunderlich NC, Beigel R, Ho SY, et al. Imaging for mitral interventions: Methods and efficacy. JACC Cardiovasc Imaging, 2018, 11(6): 872-901.
12. Bax JJ, Debonnaire P, Lancellotti P, et al. Transcatheter Interventions for mitral regurgitation: Multimodality imaging for patient selection and procedural guidance. JACC Cardiovasc Imaging, 2019, 12(10): 2029-2048.
13. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
14. 中国医师协会超声分会超声心动图专业委员会, 中华医学会超声医学分会超声心动图学组, 中华医学会心血管病分会结构性心脏病学组, 等. 二尖瓣反流介入治疗的超声心动图评价中国专家共识. 中国介入心脏病学杂志, 2019, 27(1): 6-12.
15. Lim DS, Herrmann HC, Grayburn P et al. Consensus document on non-suitability for transcatheter mitral valve repair by edge-to-edge therapy. Structural Heart, 2021, 5(3): 227-233.
16. Melillo F, Fisicaro A, Stella S, et al. Systematic fluoroscopic-echocardiographic fusion imaging protocol for transcatheter edge-to-edge mitral valve repair intraprocedural monitoring. J Am Soc Echocardiogr, 2021, 34(6): 604-613.
17. Ge Z, Pan C, Li W, et al. Real-time monitoring and step-by-step guidance for transapical mitral valve edge-to-edge repair using transesophageal echocardiography. J Interv Cardiol, 2021, 2021: 6659261.
18. Patzelt J, Zhang Y, Seizer P, et al. Effects of mechanical ventilation on heart geometry and mitral valve leaflet coaptation during percutaneous edge-to-edge mitral valve repair. JACC Cardiovasc Interv, 2016, 9(2): 151-159.
19. Borgia F, Di Mario C, Franzen O. Adenosine-induced asystole to facilitate MitraClip placement in a patient with adverse mitral valve morphology. Heart, 2011, 97(10): 864.
20. Gavazzoni M, Taramasso M, Zuber M, et al. Conceiving MitraClip as a tool: Percutaneous edge-to-edge repair in complex mitral valve anatomies. Eur Heart J Cardiovasc Imaging, 2020, 21(10): 1059-1067.
21. Singh GD, Smith TW, Rogers JH. Multi-MitraClip therapy for severe degenerative mitral regurgitation: "Anchor" technique for extremely flail segments. Catheter Cardiovasc Interv, 2015, 86(2): 339-346.
22. Taramasso M, Maisano F. Challenging mitral clefts with MitraClip: The convergent clips strategy. EuroIntervention, 2016, 12(8): e1071.
23. Cheng R, Kar S, Siegel RJ, et al. Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve repair. Catheter Cardiovasc Interv, 2019, 93(6): 1161-1164.
24. Sannino A, Grayburn PA. Mitral regurgitation in patients with severe aortic stenosis: Diagnosis and management. Heart, 2018, 104(1): 16-22.
25. 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.
26. Guyatt GH, Akl EA, Crowther M, et al. Introduction to the ninth edition: Antithrombotic therapy and prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): 48S-52S.
27. Feldman T, Foster E, Glower DD, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med, 2011, 364(15): 1395-1406.
28. Waechter C, Ausbuettel F, Chatzis G, et al. Antithrombotic treatment and its association with outcome in a multicenter cohort of transcatheter edge-to-edge mitral valve repair patients. J Cardiovasc Dev Dis, 2022, 9(11): 366.
29. 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.
30. Gheorghe L, Ielasi A, Rensing BJWM, et al. Complications following percutaneous mitral valve repair. Front Cardiovasc Med, 2019, 6: 146.
31. Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve interventions in the real world: Early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol, 2013, 62(12): 1052-1061.
32. 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.
33. 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.
34. 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.
35. 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.
36. Paukovitsch M, Schneider LM, Reichart C, et al. Prevalence of iatrogenic atrial septal defects (iASD) after mitral valve (MV) transcatheter edge-to-edge repair (TEER) in the long-term follow-up. Open Heart, 2021, 8(2): e001732.
37. 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.
38. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical pathway for transcatheter mitral valve edge-to-edge repair in China (abbreviated version 2022)

Abstract Full text Figures/Tables Video References Cited by

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