Percutaneous Mitral Repair With the MitraClip SystemSafety and Midterm Durability in the Initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) Cohort
Ted Feldman, MD*,*,
Saibal Kar, MD ,
Michael Rinaldi, MD ,
Peter Fail, MD ,
James Hermiller, MD||,
Richard Smalling, MD, PhD¶,
Patrick L. Whitlow, MD#,
William Gray, MD**,
Reginald Low, MD,
Howard C. Herrmann, MD,
Scott Lim, MD,
Elyse Foster, MD||||,
Donald Glower, MD¶¶ for the EVEREST Investigators
* Evanston Hospital, Evanston, Illinois
Cedar Sinai Medical Center, Los Angeles, California
Carolina Heart Institute, Charlotte, North Carolina
Terrebonne General Medical Center, Houma, Louisiana
|| The Care Group, Indianapolis, Indiana
¶ Houston Health Sciences Center, Houston, Texas
# The Cleveland Clinic, Cleveland, Ohio
** Columbia University, New York, New York
University of California at Davis, Sacramento, California
University of Pennsylvania, Philadelphia, Pennsylvania
University of Virginia, Charlottesville, Virginia
|||| University of California at San Francisco, San Francisco, California
¶¶ Duke University Medical Center, Durham, North Carolina
View larger version (68K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Double Orifice Surgical MV Repair With Suture
Illustration depicts a double-orifice mitral valve (MV) surgical repair. The MV is viewed from the left atrial side. The middle scallops of the anterior and posterior leaflets have been sutured together, which creates a double orifice, edge-to-edge, or bow-tie repair.
|
|
View larger version (127K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 The MitraClip Device
The device is covered with polyester fabric to facilitate tissue in-growth. The distal gripping element helps with leaflet fixation. The clip delivery system exits through a guide catheter.
|
|
View larger version (66K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Key Anatomic Eligibility Criteria
The coaptation length must be at least 2 mm. Coaptation depth must be <11 mm. If a flail leaflet exists, the flail gap must be  10 mm, and the flail width must be 15 mm. These anatomic characteristics are necessary for sufficient leaflet tissue for mechanical coaptation when the MitraClip device is used.
|
|
View larger version (35K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 Efficacy Results Through Discharge
This chart shows the flow of patients from the point of clip procedure attempt through hospital discharge. *Acute procedural success (APS) is defined as placement of 1 or more clips resulting in a discharge mitral regurgitation (MR) severity of 2+, as determined by the Core Laboratory.
|
|
|
Piece
