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

The percutaneous edge-to-edge mitral valve repair with MitraClip® 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 MitraClip® implantation but better MR reduction after surgery at 12 months. However, large registries on MitraClip® therapy showed that real-world MitraClip® 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 MitraClip® implantation. The ongoing RESHAPE trial with randomization of MitraClip® implantation against optimal medical therapy investigates a possible survival benefit after MitraClip® in patients with secondary MR.