Catheter-based mitral valve repair by MitraClip implantation. Development, studies, and use in clinical practice

The percutaneous edge-to-edge mitral valve repair with MitraClipA (R) is evolving as a potential alternative to conventional surgery in high-risk patients with significant mitral regurgitation (MR). The randomized controlled EVEREST II-trial which compared percutaneous repair versus surgery in operable patients with symptomatic severe MR demonstrated superior safety of MitraClipA (R) implantation but better MR reduction after surgery at 12 months. However, large registries on MitraClipA (R) therapy showed that real-world MitraClipA (R) patients differ significantly from the EVEREST II-cohort: they are older, in more advanced stages of heart failure, present predominantly with secondary MR, and exhibit a higher burden of comorbidities. For these patients, registry data confirm a low incidence of peri-interventional complications and a significant improvement of heart failure symptoms and quality of life measures after MitraClipA (R) implantation. The ongoing RESHAPE trial with randomization of MitraClipA (R) implantation against optimal medical therapy investigates a possible survival benefit after MitraClipA (R) in patients with secondary MR.