Assessment of the Functional Anatomy of Mitral Valve for Percutaneous Repair 

JASE, September 2011Volume 24, Issue 9, Pages 937–965 

De <http://www.onlinejase.com/article/S0894-7317(11)00507-4/fulltext>  

 

Considerations for edge-to-edge repair: EVEREST II 

 

Percutaneous edge-to-edge repair may be accomplished with an implantable clip MitraClip™ that approximates the middle scallops of the mitral valve, creating a double orifice mitral valve. As such, the predominant mechanism of MR must originate from the central mitral scallops, A2 and P2. The guidelines for selection of patients for MitraClip™ mirror the selection criteria used in the two EVEREST trials. Patients with degenerative MR (Carpentier Type II dysfunction) with either prolapse or flail of the A2 and/or P2 scallops are candidates for the MitraClip™, and in EVEREST II, represented approximately two-thirds of those evaluated. Similarly, patients with functional MR, either due to dilated cardiomyopathy or ischaemic LV remodelling, are also candidates provided the dominant MR jet arises from A2 to P2. In EVEREST II, these patients accounted for one-third of those enrolled. In EVEREST II, patients with significant MR originating from the medial or lateral aspects of the valve were excluded, as were those with rheumatic disease, endocarditis, and a mitral valve area of <4cm2. Relative contraindications also include abnormal thickness of the leaflets or calcification that would impede grasping by the device arms. Additional functional anatomic exclusions for percutaneous MitraClip™ repair exist. In patients with functional MR, those with a coapting surface length <2 mm and/or a coaptation depth of >11 mm are excluded. In patients with degenerative MR, those with a flail height of ≥10 mm and a flail width of ≥15 mm are excluded.