Percutaneous Mitral Leaflet Repair

Mitral regurgitation (MR) affects millions of patients world-wide. It is a progressive disease which worsens when left untreated. MR leads to compensatory remodeling of the left ventricle resulting in reduced functional capacity, poor quality of life, repeat hospitalizations, and eventually death from heart failure. Open, arrested heart surgery has until now been the therapeutic treatment of choice. However, many high-risk patients cannot tolerate traditional heart surgery and continue to suffer from severe MR. In this exciting new title, international key opinion leaders discuss in-depth the clinical application of percutaneous mitral valve therapies for this sub-sect of patients, focusing on the MitraClip device. These new therapeutic developments will come to form an essential component of the interventional cardiologists’ armamentarium in treating MR patients and will be of interest to every practicing cardiologist. Key topics include; An overview of the anatomy and pathophysiology of the mitral valvular complex and MR; EVEREST trial outcomes, and the development of percutaneous edge-to-edge repair; Updates on the global experience with this new therapy; Patient selection and the role of percutaneous therapies for high-risk patients; Addresses echocardiographic guidance and includes practical tips for the use of transesophageal echocardiography during procedure; Step-by-step techniques, plus tips and tricks for getting the best results for your patients; Special considerations for treating the returning MR repair patient; Discussion of the European experience since CE approval; Future directions in percutaneous mitral valve therapies. CONTENTS 1. Anatomy of the Mitral Valvular Complex 2. The Pathophysiology of Mitral Regurgitation 3. Genesis of the surgical edge-to-edge (E2E) repair 4. Outcomes from surgical edge-to-edge repair 5. An overview of the literature on surgical mitral valve repair 6. Development of Percutaneous Edge-to-Edge Repair: The MitraClip Story 7. MitraClip® System Design and History of Development 8. EVEREST Trial Results 9. Outcomes for Functional Mitral Regurgitation (FMR) 10. The role of percutaneous mitral repair for high risk patients 11. Echocardiographic Evaluation for Mitral Regurgitation Grading and Patient Selection 12. Understanding the Limits of Patient Selection for Edge-to-Edge Repair 13. The basic technique for the Evalve MitraClip procedure 14. Procedural tips & tricks 15. Training and simulation 16. Special techniques for FMR 17. The European experience since CE approval 18. An Interventionalist’s Approach to the Practical Use of TEE Guidance 19. Echo guidance 20. A Critical Appraisal of Edge-To-Edge Repair with the MitraClip 21. Technique for surgical removal of the MitraClip 22. Special considerations for MV repair after prior clip therapy 23. Gross and histologic findings after MitraClip placement 24. Future directions in percutaneous mitral therapy Ted Feldman, MD, FESC FACC FSCAI is Director, Cardiac Catheterization Laboratory at NorthShore University Health System and Evanston Hospital, IL, USA. He has been a contributor to the development of percutaneous valve therapies, beginning with balloon valvuloplasty in the 19080’s, and now with new methods for catheter based valve repair and replacement. Frederick St Goar, MD, FACC is an Interventional Cardiologist with Advanced Cardiovascular Specialists and a Director of the Fogarty Institute for Innovation at El Camino Hospital, Mt View, CA, USA. He was the physician founder of Evalve.