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Patient history, preference determine successful use of new mitral valve
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Coverage from the Transcatheter Cardiovascular Therapeutics (TCT) 2010 meeting
Surgery remains the first choice for treating patients with degenerative mitral regurgitation, but age and biological considerations may make the MitraClip percutaneous mitral valve a more favorable option in some instances.
Francesco Maisano, MD, of San Raffaele Hospital in Milan, Italy, said patients with degenerative mitral valve regurgitation who have a more positive prognosis for implantation with the MitraClip (Abbott) and a low risk for surgical complications pose a management quandary for surgeons, and that it remains particularly important in these cases to consider the individual patient’s history and personal preference.
The MitraClip, according to Maisano, may be less than optimal in patients with endocarditis or in those whose mitral annulus is too wide, adding that such patients “should usually be addressed surgically.” He also said, however, that patients with more successful outcomes tend to include cases where the jet of the mitral regurgitation is central and, in cases when the physician has to deal with a flail leaflet, the flail gap is smaller.
EVEREST II
Maisano and Ted Feldman, MD, from Evanston Hospital in Evanston, Ill., pointed to current data from the EVEREST II trial suggesting positive results in a subset of patients with degenerative mitral regurgitation.
For the EVEREST II trial, 279 patients with mitral regurgitation (grade 3 to 4) were randomly assigned to receive the MitraClip or surgery at their surgeon’s discretion. In this subgroup of patients with degenerative mitral regurgitation, a substantial proportion of patients in both the surgery and MitraClip groups achieved grade 1 or 2 mitral regurgitation at 1 year. According to Feldman, mitral regurgitation reduction was superior in the surgical patients vs. device patients. Both groups also reported improvements in quality of life at 30 days and 12 months.
Alfredo Trento, MD, of Cedars-Sinai Medical Center in Los Angeles, noted that while the data from a small group of patients from the EVEREST II trial (n=37) were limited, he pointed out that precutaneous mitral valve device implantation appeared safe in the group, and that the preferred surgical procedure (either repair or replacement) can still be performed in most cases.
Maisano said new technologies such as transcatheter annuloplasty devices (being developed by companies such as GDS, Mitralign and Valtech) will likely offer additional alternatives to surgery in the future.
Disclosures:
- Dr. Feldman reports receiving research support from Atritech, Edwards Lifesciences, Abbott Vascular and Boston Scientific.
- Dr. Maisano reports serving as a consultant for Medtronic, Abbott Vascular, St. Jude Medical and Valtech.