Percutaneous mitral valve repair

High-risk patients with mitral regurgitation (MR) can be treated with the MitraClip treatment. Two main issues regarding the identification of patients for the MitraClip treatment are addressed in this thesis. First, the guidelines state that patients should have a reasonable life expectancy to be eligible for MitraClip treatment. Complying to the guidelines remains challenging as estimating the prognosis after MitraClip treatment is complex. Second, the vast majority of the patients undergoing MitraClip treatment experienced improvement of the symptoms. However, it is difficult and important to preprocedurally identify which patients may benefit from the MitraClip. The aim of this thesis is to provide insight in the identification of patients who are eligible and may benefit from percutaneous mitral valve repair with the MitraClip.
This thesis reports the current prevalence of valvular heart diseases and shows an overview of the increasing experience with the MitraClip. In order to estimate the prognosis after MitraClip treatment, risk stratification models are compared and developed. To identify which patients may benefit from the MitraClip, preprocedural predictors are identified. High sensitive Troponin T ≥ 0.05 µg/L, myocardial fibrosis and decreased MR during the preprocedural stress echocardiography predicted limited clinical benefit after the MitraClip implantation.
Finally, the preprocedural decision making, patient-specific preparation of the procedure and the new high-potential options for percutaneous mitral valve repairs and replacements are discussed in the future perspectives.