Mitral Transcatheter Edge-to-Edge Repair eBook-M-TEER eBook

M-TEER eBook
Pdf Summary
This comprehensive guide from the Society for Cardiovascular Angiography and Interventions details the transcatheter edge-to-edge repair (TEER) procedure for treating mitral regurgitation (MR), primarily via the MitraClip device. It covers foundational concepts, patient evaluation, technical procedural steps, and management of complications.<br /><br />The MitraClip, an adaptation of the surgical Alfieri stitch, approximates mitral valve leaflets to reduce MR. Since its first human implantation in 2003, it has evolved through multiple generations, now in the fourth, enabling treatment of diverse mitral pathologies, including primary (degenerative) and secondary (functional) MR.<br /><br />Pre-procedure evaluation emphasizes comprehensive imaging, especially transthoracic and transesophageal echocardiography, to assess mitral valve anatomy, MR mechanism, and severity. Essential anatomic criteria include leaflet length and mobility, mitral valve area, and the presence of mitral annular calcification. Multi-modality imaging like MRI and CT aids in complex cases.<br /><br />Patient selection has broadened beyond initial strict clinical trials criteria due to technological advances and operator experience, now addressing challenging conditions such as large flail gaps, non-central pathology, Barlow’s disease, prior surgical repairs, and select cases of secondary MR following guideline-directed medical therapy.<br /><br />The detailed procedural sections describe vascular access via ultrasound-guided right femoral vein puncture, transseptal puncture tailored by MR etiology and leaflet pathology, advanced left atrial steering with intracardiac echocardiographic guidance, precise clip alignment, and careful advancement into the left ventricle to optimize leaflet grasping. Controlled gripper actuation allows independent leaflet grasping to improve outcomes in complex anatomies.<br /><br />Post-deployment, residual MR evaluation determines the necessity of additional clips, with attention to mitral valve gradients to avoid stenosis. Complications such as single leaflet device attachment, chordal entanglement, and device embolization are addressed with prevention strategies and management algorithms including device retrieval techniques.<br /><br />Special considerations include MitraClip use post surgical mitral valve repair, addressing anatomical changes like annuloplasty rings or artificial chords, and emerging guidance methods employing volumetric intracardiac echocardiography as an alternative to transesophageal echocardiography, potentially facilitating procedures in patients unable to tolerate traditional imaging.<br /><br />An interactive decision-making algorithm and procedural checklists support clinicians in systematically navigating the TEER procedure. This evolving field reflects multidisciplinary collaboration, technological innovation, and procedural expertise aimed at improving patients' quality of life with mitral valve disease.
Keywords
Transcatheter Edge-to-Edge Repair
TEER
MitraClip
mitral
Mitral Regurgitation
Mitral Valve Repair
Echocardiography
Transseptal Puncture
Leaflet Grasping
Device Complications
Intracardiac Echocardiography