Journal of Cardiac Surgery | 2021
Real‐time echocardiographic guidance for transcatheter repair noncentral mitral regurgitation using the novel ValveClamp system
Abstract
A 70‐year‐old male patient had a history of recent acute myocardial infarction, complicated with mitral valve prolapse (P1 and P2) and severe noncenter mitral regurgitation (Figure 1A). Since the distance between the mitral anterior leaflet and posterior leaflet was more than 15mm, capturing the leaflet tissues of the noncentral mitral regurgitation was deemed challenging when using MitraClip NTR/ XTR. Thus, he was referred for transcatheter mitral valve repair with the ValveClamp system (Hanyu Medical Technology), a novel edge‐to‐edge mitral regurgitation repair system designed for ease of operation and a wider range of clinical indications requiring mitral regurgitation correction. The whole procedure was performed under general anesthesia guided using transesophageal echocardiography. Transapical access was obtained via a mini‐anterolateral thoracotomy. A soft spheroidal valve‐crossing device, woven using NiTi wire, guided the 16Fr delivery sheath passed through the mitral valve apparatus into the left atrium (Figure 1D). Afterward, two V‐shape matched arms passed over the sheath and were released in the left atrium (Figure 1E). We adjusted the two arms position and direction and captured the anterior and posterior leaflets (A2 and P2 scallop). After the first clamp was deployed, a mild residue MR in the P1 scallop was noted (Figure 1F). After the transvalvular pressure gradient was checked, we implanted another small‐size ValveClamp (2 mm smaller) (Figure 1G). Finally, the residual mitral regurgitation disappeared (Figure 1H–J) and the postoperative mean transvalvular pressure gradient of the mitral valve was only 5 mmHg (Figure 1K,L). The patient was discharged 5 days after the surgery. At 30 days, the patient did not experience a stroke, tamponade, major bleeding, or any other procedure‐related severe adverse events. Follow‐up echocardiograms revealed slight mitral regurgitation. This case was from a multicenter large‐scale clinical trial (NCT03869164), which is being conducted in China to evaluate the safety and efficiency of theValveClamp system in mitral regurgitation correction. Our case displayed some unique designs of the system: the valve‐cross device can help with avoiding the chordae tendineae; the two matched V‐shape clamping arms can capture a wider area; and the transapical approach makes locating and clamping easier to operate, a step that can be finished over a short period. Furthermore, the whole process is guided solely by real‐time three‐dimensional transesophageal echocardiography, eliminating the need for X‐ray. Moreover, the smaller‐sized clamp can help expand the indications for transcatheter mitral valve repair and lower the risk of mitral stenosis.