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• W2905937515 abstract "We thank Dr Kassem for his interest [1Kassem S. Should we go further with MitraClip without simultaneously developing percutaneous annuloplasty? (letter).Ann Thorac Surg. 2019; 107: 1289Abstract Full Text Full Text PDF Scopus (1) Google Scholar] in our case report [2Hermanns H. Wiegerinck E.M.A. Lagrand W.K. Baan Jr., J. Cocchieri R. Kaya A. Two cases of endocarditis after MitraClip procedure necessitating surgical mitral valve replacement.Ann Thorac Surg. 2019; 107: e101-e103Abstract Full Text Full Text PDF Scopus (9) Google Scholar]. In his letter he mentions alternative, physiology-based methods for the treatment of mitral valve regurgitation (MR) such as artificial chord implantation and mitral annuloplasty. MR is a very common and likely increasing condition responsible for considerable morbidity and mortality. Besides the gold standard of open mitral valve surgery, percutaneous mitral valve repair has seen an enormous development in recent years for both primary and secondary MR. Thus a multitude of innovative treatment devices have been developed, based on various concepts: edge-to-edge repair (MitraClip, Pascal system), annuloplasty (eg, Cardioband, Mitralign, Carillon Mitral Contour System, Arto System, Iris device, Amend device), ventricular reshaping (eg, VenTouch system, AccuCinch system), or chordal techniques (eg, NeoChord DS1000 device, TSD-5 mitral valve repair device), part of which have gained US Food and Drug Administration approval or CE (Conformité Européenne) mark, respectively. Among the available devices the MitraClip system is currently by far the most frequently used. Here, patient selection is crucial, given seemingly contradictory results of recent investigations [3Obadia J.F. Messika-Zeitoun D. Leurent G. et al.Percutaneous repair or medical treatment for secondary mitral regurgitation.N Engl J Med. 2018; 379: 2297-2306Crossref PubMed Scopus (983) Google Scholar, 4Stone G.W. Lindenfeld J. Abraham W.T. et al.Transcatheter mitral-valve repair in patients with heart failure.N Engl J Med. 2018; 379: 2307-2318Crossref PubMed Scopus (1514) Google Scholar]. Mitral annuloplasty and other percutaneous treatments might represent very valuable additions in the future of treatment of MR, alone or in concert. In surgical treatment of MR the combination of annuloplasty and neochordae has shown good long-term results and can be considered the gold standard with appropriate indication. Thus in our view the answer to the question, “Should we go further with MitraClip without simultaneously developing percutaneous annuloplasty?,” is no: We should apply a percutaneous technique that mimics the surgical MV treatment as close as possible with annuloplasty and neochordae, like for example the combination of Cardioband and NeoChord. Meticulous research is necessary to evaluate which surgical or interventional therapy represents the optimal approach for which group of patients. However, surgical bailout therapy might remain an option for patients initially declined for surgical procedures, as depicted in our case report. Should We Go Further With MitraClip Without Simultaneously Developing Percutaneous Annuloplasty?The Annals of Thoracic SurgeryVol. 107Issue 4PreviewI found the article by Hermanns and colleagues [1] very interesting. They presented two cases of endocarditis after MitraClip procedures. Despite the small number of patients, Hermanns and colleagues [1] brought into focus the problem of candidate selection for new technologies (in this case the MitraClip system). The main reason for patients to undergo a MitraClip procedure is to avoid the adverse effects of cardiopulmonary bypass. Full-Text PDF" @default.
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