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Kirurgija » | Latest edition »

Percutaneous Treatment of Mitral Regurgitation with MitraClip System

 

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Mitral regurgitation is defined as a systolic retrograde blood flow from the left ventricle to the left atrium. Moderate or severe mitral regurgitation can be found in 10% of people older than 75 years. It is treated surgically, usually by valvuloplasty. Patients treated by medical treatment alone have a poor prognosis. Percutaneous treatment is becoming the treatment of choice for patients at high surgical risk. It is indicated in patients with severe, symptomatic mitral regurgitation and patients with severe mitral regurgitation associated with left ventricular dysfunction. We can treat both, patients with degenerative and functional mitral regurgitation. It can be used in patients with all three types of mitral regurgitation as defined by Carpentier classification, with the exception of type IIIa. The goal is to reduce the size of the regurgitation orifice by clamping both mitral leaflets. The procedure is carried out through the inguinal vein using a special guiding catheter and a clip delivery system. It is guided by fluoroscopy and transesophageal echocardiography. During the procedure we have to perform a trans-septal puncture between both atria. If necessary, we can insert more than one clip. After the procedure, patients should be receiving clopidogrel (75mg per day) for one month and a life-long therapy with acetylsalicylic acid (100 mg per day). Possible complications are those associated with cardiac catheterization and trans-septal puncture. Acute renal failure is more frequent than in other interventional procedures, another possible complication is clip detachment. Initially the procedure does not reach the results of surgical treatment, but the difference decreases with time and becomes statistically insignificant at four years follow up. Oneyear survival rate is approximately 50% better than in patients on medical treatment. In 53% of patients, regurgitation decreases for two grades or more.

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