Echocardiographic guidance and assessment of percutaneous repair for mitral regurgitation with the evalve MitraClip: Lessons learned from EVEREST I

被引:139
作者
Silvestry, Frank E.
Rodriguez, L. Leonardo
Herrmann, Howard C.
Rohatgi, Sameer
Weiss, Stuart J.
Stewart, William J.
Homma, Shunichi
Goyal, Neil
Pulerwitz, Todd
Zunamon, Alan
Hamilton, Andrew
Merlino, John
Martin, Randolph
Krabill, Kimberly
Block, Peter C.
Whitlow, Pat
Tuzcu, E. Murat
Kapadia, Samir
Gray, William A.
Reisman, Mark
Wasserman, Hal
Schwartz, Allan
Foster, Elyse
Feldman, Ted
Wiegers, Susan E.
机构
[1] Penn Cardiac Care Radnor, Div Cardiovasc, Radnor, PA 19087 USA
[2] Univ Penn, Dept Med, Div Cardiovasc, Philadelphia, PA 19104 USA
[3] Hosp Univ Penn, Dept Anesthesia & Crit Care, Philadelphia, PA 19104 USA
[4] Cleveland Clin, Cleveland, OH 44106 USA
[5] Columbia Univ, Dept Med, Div Cardiovasc, New York, NY USA
[6] Northwestern Univ, Evanston Hosp, Dept Med, Div Cardiovasc, Evanston, IL 60201 USA
[7] Emory Univ, Dept Med, Div Cardiovasc, Atlanta, GA 30322 USA
[8] Swedish Med Ctr, Dept Med, Div Cardiovasc, Seattle, WA USA
[9] Univ Calif San Francisco, Dept Med, Div Cardiovasc, San Francisco, CA USA
关键词
DOUBLE-ORIFICE TECHNIQUE; TO-EDGE TECHNIQUE; VALVE REPAIR; HEART-FAILURE; MODEL; FEASIBILITY; REDUCTION; EFFICACY; FLOW;
D O I
10.1016/j.echo.2007.02.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. Percutaneous mitral repair is rapidly developing as an alternative to cardiac surgery in select patients. The Evalve percutaneous E2E system uses the MitraClip to replicate the surgical suture-based approach. This procedure requires real-time echocardiographic guidance in a unique and significant collaboration between echocardiographer and interventionalist. transesophageal echocardiography (TEE) is used as the primary imaging modality to guide this procedure and is essential to its success. Methods: in EVEREST I, die US multicenter phase I safety and feasibility trial, 47 patients with 3 or 4+ mitral regurgitation (MR) were enrolled. The trial involved a standardized echocardiographic imaging protocol with a standardized anatomic-based vocabulary, predetermined standard TEE views, preprocedural strategy meetings, and display of echocardiographic aids to optimize communication and procedural efficiency during placement of the clip. Results: TEE guidance facilitated the creation of a double-orifice mitral valve in all 47 patients enrolled (100%), and 40 patients were discharged with 1 or more clips (85%). At discharge, successful placement of a clip and <= 2+ MR was present in 34 patients (74%). The standardized approach contributed to a reduction in the time to perform the procedure over the course of the trial at both initial and new sites. Conclusions: TEE is essential to the guidance of percutaneous MitraClip E2E repair. A streamlined approach to echocardiographic guidance, using predetermined standardized views, a common anatomic-based vocabulary, preprocedural strategy meetings, and a display of echocardiographic aids in the catheterization laboratory shortens the procedure time and allows for efficient percutaneous repair.
引用
收藏
页码:1131 / 1140
页数:10
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