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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Symptomatic patients with severe MR should be referred to a cardiac surgical centre for consideration of mitral valve surgery. Surgery depends on anatomy and comorbidities and is either a surgical repair or mitral valve replacement. In patients with very high perioperative risk due to comorbidities, a percutaneous MitraClip may be indicated. Guidelines provide thresholds of LV volumes and function at which surgery is recommended in asymptomatic patients with severe MR before LV dysfunction develops.
The Mitral Valve
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Overview of the MitraClip® System: The MitraClip is a clip that attaches the leaflets of mitral valve designed to treat mitral regurgitation. It allows the mitral valve to coapt more completely and helps restore blood flow through left ventricle. It is a less invasive treatment option for MR which is a valid alternative to conventional mitral valve surgery for MR (Figure 9.4.15).
Interventional transoesophageal echocardiography
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Mayooran Namasivayam, Martin Shaw
Various approaches to mitral valve repair using a percutaneous approach are available, including direct repair of leaflets, annuloplasty, annuloplasty-coronary sinus procedures and ventricular remodelling approaches. Mitral valve repair using the MitraClip device is an increasingly common procedure (see Chapter 30). This procedure, derived from the Alfieri method of surgically joining the anterior and posterior leaflet, requires careful visualisation of valve leaflets, and documentation of coaptation defects in the three anatomical planes.
Evaluating the Cost-Effectiveness of Transcatheter Mitral Valve Therapies for the Treatment of Mitral Regurgitation: “To Infinity and Beyond”
Published in Structural Heart, 2020
While the MitraClip may have been the first percutaneous device to treat mitral regurgitation market, it is not the only device being developed. There are many devices in various stages of active investigation at this time and the range of these devices is reflective of the diversity of the disease process and treatment options of mitral regurgitation. There are devices aimed at replicating a surgical annuloplasty (Millipede, Boston Scientific Corporation, Marlborough, Massachusetts), spacing devices placed within the mitral valve to improve leaflet coaptation (Pascal, Edwards Lifesciences, Irvine, California), and percutaneous mitral valve replacements (Tendyne, Abbott Structural Heart, Santa Clara, California; Intrepid, Medtronic, Minneapolis, Minnesota). Given that the up-front cost of these novel devices will likely be substantial, whether any of these devices will prove to be cost-effective will depend on their ability to either improve survival or to decrease healthcare resource utilization in the long-run.
Cost-effectiveness analysis of percutaneous mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation in Japan
Published in Journal of Medical Economics, 2019
Hiroyuki Sakamaki, Koichi Nakao, Takashi Matsumoto, Sachie Inoue
With reference to the expert’s opinion, medical treatment for adverse events (non-elective cardiovascular surgery due to adverse events related to a device or procedure) was assumed to be “percutaneous pericardial drainage”, and medical fee for the corresponding procedure was calculated. With reference to the expert’s opinion, medical treatment for adverse events (GI complication requiring surgery) was assumed to be “endoscopic gastrointestinal hemostasis (K654)”. As for hospitalization cost for septicemia, points for corresponding DPC (A419) was used14. The details of the type of MitraClip complications were cited from the report of Velazquez et al.10. Costs associated to those complications were set to be costs of representative treatments based on the expert’s opinion.
Impact of Atrial Fibrillation on the Outcomes after MitraClip®: A Meta-Analysis
Published in Structural Heart, 2018
Michael Megaly, Bishoy Abraham, Marwan Saad, Mohamed Omer, Ayman Elbadawi, Mariam Tawadros, Charl Khalil, Ramez Nairoz, Ahmed Almomani, Jay Sengupta, Ankur Kalra, Emmanouil Brilakis, Sameer Gafoor
The MitraClip® (Abbott Vascular, Santa Clara, CA, USA) is a transvenous percutaneous device that facilitates an edge-to-edge repair leading to a double-orifice competent mitral valve by the application of the MitraClip® across the diseased valve. Outcomes of MitraClip® compared with surgery have been well-described in many studies including the Endovascular Valve Edge-to-Edge Repair Study II (EVEREST II) trial.1 A meta-analysis by Wan et al. comparing surgical versus percutaneous mitral valve repair found no difference in 1-year mortality and re-operation rate.2 In the current 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, transcatheter mitral valve repair is considered reasonable in patients with symptomatic severe chronic primary mitral regurgitation (MR) with favorable anatomy and a prohibitive risk for surgical repair, if they remain symptomatic despite optimal medical therapy.3