The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Incidence and Standardized Definitions of Mitral Valve Leaflet Adverse Events After Transcatheter Mitral Valve Repair: the EXPAND Study

DOI: 10.4244/EIJ-D-21-00012

1.Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, United States
2. Houston Methodist Hospital, Houston, Texas, USA
3. University of Washington Medical Center, Seattle, USA
4. Baylor University Medical Center, Dallas, Texas, USA
5. Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
6. Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC, USA
7. University Heart Center, University Hospital Zurich, Zurich, Switzerland
8. Los Robles Regional Medical Center, Thousand Oaks, California, USA

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Background: An independent panel of experts reviewed all investigator-reported cases of mitral valve leaflet adverse events (LAE) after MitraClipTM NTR/XTR in the EXPAND Study.

Aims: We aimed to report the findings of the expert panel and standardize definitions for LAE.   

Methods: Standard definitions for different types of LAE were formulated and events adjudicated after detailed review by the expert panel.

Results: Enrolling centers reported LAE in 35 cases, 11 leaflet injuries (9 tear, 2 perforation) and 24 single leaflet device attachment (SLDA). The panel confirmed LAE in 20 cases (2.0% incidence), 18 patients had SLDA and 4 had leaflet injury (2 cases had both SLDA and injury). Leaflet injury occurred during device implant and resulted in surgical valve replacement or death. SLDA-alone events were identified during implant (n=2), pre-discharge (7) or at 30 days of follow-up (7) and were resolved (£ 2+ residual MR) with additional clips in 75% of cases.

Conclusions: Mitral valve repair with MitraClipTM NTR/XTR is safe. The rate of LAE is lower than previously reported using older generation devices. The proposed definitions and findings will help differentiate leaflet injury from inadequate leaflet insertion and SLDA, and provide guidance to consistently diagnose LAE post MitraClipTM.

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