Transcatheter edge-to-edge repair (TEER): Past, current and future perspectives_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Wenzhi ^1,2 , LONG Yuliang ^1,2 ,  ZHOU Daxin ^1,2 ,  GE Junbo ^1,2

1. Department of Cardiology, Zhongshan Hospital, Fudan University, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Shanghai, 200032, P.R.China;
2. National Clinical Research Center for Interventional Medicine, Shanghai, 200032, P.R.China;

Corresponding author：

ZHOU Daxin, Email: zhou_daxin@sina.com; GE Junbo, Email: ge.junbo2@zs-hospital.sh.cn

Keywords：

Transcatheter edge-to-edge repair (TEER); mitral regurgitation; progress

DOI：

10.7507/1007-4848.202104067

Video：

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Transcatheter edge-to-edge repair (TEER) originated from surgical edge-to-edge repair. MitraClip is the first mature TEER device, and the TEER based on MitraClip is far ahead of many transcatheter mitral valve repair (TMVr) technologies in terms of safety, effectiveness and popularity, so it is named separately in the latest guidelines. The TEER has the following advantages: consistent with basic medical principles, few implants, precise target, less invasive and repeatable. However, there are also some shortcomings, such as the relatively complex design of transfemoral device, target single and relatively narrow indications. At present, the main clinical data of TEER are mainly from the clinical practice of MitraClip. Based on the three-year outcomes of COAPT study, both 2020 ACC/AHA guideline and 2020 ACC expert consensus decision pathway on the management of mitral regurgitation recommend in patients with chronic heart failure with left ventricular dysfunction and severe mitral regurgitation in nonresponders to medicine treatment. Edward's PASCAL, another TEER device, has two models. Among the domestic TEER devices, the ValveClamp of Hanyu medical technology has many distinct advantages, such as simple operation, large clamping area, high clamping efficiency and no need of X-ray. DragonFly, another domestic TEER device, has also completed its feasibility study. There are five trends of TEER in the future: further expansion of indications, combination with other interventional techniques, repeatable operations, transcatheter mitral valve replacement after TEER, and continuous improvement and innovation of equipment.

Citation： PAN Wenzhi, LONG Yuliang, ZHOU Daxin, GE Junbo. Transcatheter edge-to-edge repair (TEER): Past, current and future perspectives. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1409-1414. doi: 10.7507/1007-4848.202104067 Copy

1.	Rubin J, Aggarwal SR, Swett KR, et al. Burden of valvular heart diseases in Hispanic/Latino individuals in the United States: The echocardiographic study of Latinos. Mayo Clin Proc, 2019, 94(8): 1488-1498.
2.	Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: A community cohort study. Lancet, 2018, 391(10124): 960-969.
3.	Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: Clinical context and outcome. Eur Heart J, 2019, 40(27): 2194-2202.
4.	Maisano F, Caldarola A, Blasio A, et al. Midterm results of edge-to-edge mitral valve repair without annuloplasty. J Thorac Cardiovasc Surg, 2003, 126(6): 1987-1997.
5.	Maisano F, Torracca L, Oppizzi M, et al. The edge-to-edge technique: A simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg, 1998, 13(3): 240-245.
6.	Alfieri O, Elefteriades JA, Chapolini RJ, et al. Novel suture device for beating-heart mitral leaflet approximation. Ann Thorac Surg, 2002, 74(5): 1488-1493.
7.	Naqvi TZ, Buchbinder M, Zarbatany D, et al. Beating-heart percutaneous mitral valve repair using a transcatheter endovascular suturing device in an animal model. Catheter Cardiovasc Interv, 2007, 69(4): 525-531.
8.	Webb JG, Maisano F, Vahanian A, et al. Percutaneous suture edge-to-edge repair of the mitral valve. EuroIntervention, 2009, 5(1): 86-89.
9.	St Goar FG, Fann JI, Komtebedde J, et al. Endovascular edge-to-edge mitral valve repair: Short-term results in a porcine model. Circulation, 2003, 108(16): 1990-1993.
10.	Condado JA, Acquatella H, Rodriguez L, et al. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv, 2006, 67(2): 323-325.
11.	Couture P, Cloutier-Gill LA, Ducharme A, et al. MitraClip intervention as rescue therapy in cardiogenic shock: One-year follow-up. Can J Cardiol, 2014, 30(9): 1108. e15-6.
12.	Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol, 2020, 76(25): 3022-3055.
13.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
14.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
15.	Mack MJ, Lindenfeld J, Abraham WT, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol, 2021, 77(8): 1029-1040.
16.	Praz F, Spargias K, Chrissoheris M, et al. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: A multicentre, prospective, observational, first-in-man study. Lancet, 2017, 390(10096): 773-780.
17.	Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST Ⅱ. J Am Coll Cardiol, 2015, 66(25): 2844-2854.
18.	Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: A STS/ACC TVT registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
19.	Sorajja P, Ukaigwe AC. Edge-to-edge repair: Past challenge, current case selection and future advances. Ann Cardiothorac Surg, 2021, 10(1): 43-49.
20.	Cheng R, Kar S, Siegel RJ, et al. Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve repair. Catheter Cardiovasc Interv, 2019, 93(6): 1161-1164.
21.	Carabello BA. MitraClip and tertiary mitral regurgitation-mitral regurgitation gets curiouser and curiouser. JAMA Cardiol, 2019, 4(4): 307-308.
22.	Oh NA, Kampaktsis PN, Gallo M, et al. An updated meta-analysis of MitraClip versus surgery for mitral regurgitation. Ann Cardiothorac Surg, 2021, 10(1): 1-14.
23.	Bonow RO, O'Gara PT, Adams DH et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: A report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
24.	Chakravarty T, Makar M, Patel D et al. Transcatheter edge-to-edge mitral valve repair with the MitraClip G4 system. JACC Cardiovasc Interv, 2020, 13(20): 2402-2414.
25.	Lim DS, Kar S, Spargias K et al. Transcatheter valve repair for patients with mitral regurgitation: 30-day results of the CLASP study. JACC Cardiovasc Interv, 2019, 12(14): 1369-1378.
26.	Pan W, Zhou D, Wu Y, et al. First-in-human results of a novel user-friendly transcatheter edge-to-edge mitral valve repair device. JACC Cardiovasc Interv, 2019, 12(23): 2441-2443.
27.	Ge Z, Pan W, Zhou D, et al. Effect of a novel transcatheter edge-to-edge repair device on the three-dimensional geometry of mitral valve in degenerative mitral regurgitation. Catheter Cardiovasc Interv, 2021, 97(1): 177-185.
28.	Pan W, Pan C, Jilaihawi H, et al. A novel user-friendly transcatheter edge-to-edge mitral valve repair device in a porcine model. Catheter Cardiovasc Interv, 2019, 93(7): 1354-1360.
29.	Raphael CE, Malouf JF, Maor E, et al. A hybrid technique for treatment of commissural primary mitral regurgitation. Catheter Cardiovasc Interv, 2019, 93(4): 692-698.
30.	Bartel T, Khalil M, Traina M et al. Percutaneous mitral annuloplasty complements clip implantation in functional mitral regurgitation. Eur Heart J, 2019, 40(31): 2584.
31.	Braun D, Näbauer M, Massberg S, et al. One-stop shop: Simultaneous direct mitral annuloplasty and percutaneous mitral edge-to-edge repair in a patient with severe mitral regurgitation. Catheter Cardiovasc Interv, 2019, 93(5): E318-E319.
32.	Kovach CP, Bell S, Kataruka A, et al. Outcomes of urgent/emergent transcatheter mitral valve repair (MitraClip): A single center experience. Catheter Cardiovasc Interv, 2021, 97(3): E402-E410.
33.	Marquetand C, Reil JC, Saad M, et al. Treatment of recurrent MR by MitraClip XTR in a patient with a PASCAL device. JACC Cardiovasc Interv, 2019, 12(24): e219-e221.
34.	El-Shurafa H, Arafat AA, Albabtain MA, et al. Reinterventions after transcatheter edge to edge mitral valve repair: Is early clipping warranted? J Card Surg, 2020, 35(12): 3362-3367.

1. Rubin J, Aggarwal SR, Swett KR, et al. Burden of valvular heart diseases in Hispanic/Latino individuals in the United States: The echocardiographic study of Latinos. Mayo Clin Proc, 2019, 94(8): 1488-1498.
2. Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: A community cohort study. Lancet, 2018, 391(10124): 960-969.
3. Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: Clinical context and outcome. Eur Heart J, 2019, 40(27): 2194-2202.
4. Maisano F, Caldarola A, Blasio A, et al. Midterm results of edge-to-edge mitral valve repair without annuloplasty. J Thorac Cardiovasc Surg, 2003, 126(6): 1987-1997.
5. Maisano F, Torracca L, Oppizzi M, et al. The edge-to-edge technique: A simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg, 1998, 13(3): 240-245.
6. Alfieri O, Elefteriades JA, Chapolini RJ, et al. Novel suture device for beating-heart mitral leaflet approximation. Ann Thorac Surg, 2002, 74(5): 1488-1493.
7. Naqvi TZ, Buchbinder M, Zarbatany D, et al. Beating-heart percutaneous mitral valve repair using a transcatheter endovascular suturing device in an animal model. Catheter Cardiovasc Interv, 2007, 69(4): 525-531.
8. Webb JG, Maisano F, Vahanian A, et al. Percutaneous suture edge-to-edge repair of the mitral valve. EuroIntervention, 2009, 5(1): 86-89.
9. St Goar FG, Fann JI, Komtebedde J, et al. Endovascular edge-to-edge mitral valve repair: Short-term results in a porcine model. Circulation, 2003, 108(16): 1990-1993.
10. Condado JA, Acquatella H, Rodriguez L, et al. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv, 2006, 67(2): 323-325.
11. Couture P, Cloutier-Gill LA, Ducharme A, et al. MitraClip intervention as rescue therapy in cardiogenic shock: One-year follow-up. Can J Cardiol, 2014, 30(9): 1108. e15-6.
12. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol, 2020, 76(25): 3022-3055.
13. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
14. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
15. Mack MJ, Lindenfeld J, Abraham WT, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol, 2021, 77(8): 1029-1040.
16. Praz F, Spargias K, Chrissoheris M, et al. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: A multicentre, prospective, observational, first-in-man study. Lancet, 2017, 390(10096): 773-780.
17. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST Ⅱ. J Am Coll Cardiol, 2015, 66(25): 2844-2854.
18. Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: A STS/ACC TVT registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
19. Sorajja P, Ukaigwe AC. Edge-to-edge repair: Past challenge, current case selection and future advances. Ann Cardiothorac Surg, 2021, 10(1): 43-49.
20. Cheng R, Kar S, Siegel RJ, et al. Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve repair. Catheter Cardiovasc Interv, 2019, 93(6): 1161-1164.
21. Carabello BA. MitraClip and tertiary mitral regurgitation-mitral regurgitation gets curiouser and curiouser. JAMA Cardiol, 2019, 4(4): 307-308.
22. Oh NA, Kampaktsis PN, Gallo M, et al. An updated meta-analysis of MitraClip versus surgery for mitral regurgitation. Ann Cardiothorac Surg, 2021, 10(1): 1-14.
23. Bonow RO, O'Gara PT, Adams DH et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: A report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
24. Chakravarty T, Makar M, Patel D et al. Transcatheter edge-to-edge mitral valve repair with the MitraClip G4 system. JACC Cardiovasc Interv, 2020, 13(20): 2402-2414.
25. Lim DS, Kar S, Spargias K et al. Transcatheter valve repair for patients with mitral regurgitation: 30-day results of the CLASP study. JACC Cardiovasc Interv, 2019, 12(14): 1369-1378.
26. Pan W, Zhou D, Wu Y, et al. First-in-human results of a novel user-friendly transcatheter edge-to-edge mitral valve repair device. JACC Cardiovasc Interv, 2019, 12(23): 2441-2443.
27. Ge Z, Pan W, Zhou D, et al. Effect of a novel transcatheter edge-to-edge repair device on the three-dimensional geometry of mitral valve in degenerative mitral regurgitation. Catheter Cardiovasc Interv, 2021, 97(1): 177-185.
28. Pan W, Pan C, Jilaihawi H, et al. A novel user-friendly transcatheter edge-to-edge mitral valve repair device in a porcine model. Catheter Cardiovasc Interv, 2019, 93(7): 1354-1360.
29. Raphael CE, Malouf JF, Maor E, et al. A hybrid technique for treatment of commissural primary mitral regurgitation. Catheter Cardiovasc Interv, 2019, 93(4): 692-698.
30. Bartel T, Khalil M, Traina M et al. Percutaneous mitral annuloplasty complements clip implantation in functional mitral regurgitation. Eur Heart J, 2019, 40(31): 2584.
31. Braun D, Näbauer M, Massberg S, et al. One-stop shop: Simultaneous direct mitral annuloplasty and percutaneous mitral edge-to-edge repair in a patient with severe mitral regurgitation. Catheter Cardiovasc Interv, 2019, 93(5): E318-E319.
32. Kovach CP, Bell S, Kataruka A, et al. Outcomes of urgent/emergent transcatheter mitral valve repair (MitraClip): A single center experience. Catheter Cardiovasc Interv, 2021, 97(3): E402-E410.
33. Marquetand C, Reil JC, Saad M, et al. Treatment of recurrent MR by MitraClip XTR in a patient with a PASCAL device. JACC Cardiovasc Interv, 2019, 12(24): e219-e221.
34. El-Shurafa H, Arafat AA, Albabtain MA, et al. Reinterventions after transcatheter edge to edge mitral valve repair: Is early clipping warranted? J Card Surg, 2020, 35(12): 3362-3367.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Transcatheter edge-to-edge repair (TEER): Past, current and future perspectives

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