OBJECTIVES This study sought to evaluate the clinical results of a percutaneous approach to mitral valve
repair for mitral regurgitation (MR).
BACKGROUND A surgical technique approximating the middle scallops of the mitral leaflets to create a
double orifice with improved leaflet coaptation was introduced in the early 1990s. Recently,
a percutaneous method to create the same type of repair was developed. A trans-septal
approach was used to deliver a clip device that grasps the mitral leaflet edges to create the
double orifice.
METHODS General anesthesia, fluoroscopy, and echocardiographic guidance are used. A 24-F guide is
positioned in the left atrium. The clip is centered over the mitral orifice, passed into the left
ventricle, and pulled back to grasp the mitral leaflets. After verification that MR is reduced,
the clip is released.
RESULTS Twenty-seven patients had six-month follow-up. Clips were implanted in 24 patients. There
were no procedural complications and four 30-day major adverse events: partial clip
detachment in three patients, who underwent elective valve surgery, and one patient with
post-procedure stroke that resolved at one month. Three additional patients had surgery for
unresolved MR, leaving 18 patients free from surgery. In 13 of 14 patients with reduction of
MR to 2 after one month, the reduction was maintained at six months.
CONCLUSIONS Percutaneous edge-to-edge mitral valve repair can be performed safely and a reduction in MR
can be achieved in a significant proportion of patients to six months. Patients who required
subsequent surgery had elective mitral valve repair or intended replacement