Percutaneous Mitral Valve Leaflet Repair for Mitral Regurgitation - Not Why, But Who?
Published date : 25 October 2012
Article date : 25 October 2012
The debate surrounding percutaneous mitral valve leaflet repair for mitral regurgitation is not dissimilar to the TAVI debate, explored in our September journal. The key differences are that, by comparison, TAVI procedures have accelerated and the procedure has generated greater media coverage on patient selection and outcomes for those outside high-risk and inoperable categories.
Nevertheless, a debate prevails on percutaneous mitral valve leaflet repair for mitral regurgitation as an alternative to valve surgery, for non-traditional patient cohorts. Percutaneous mitral valve leaflet repair is effective and less traumatic for patients and there are several medical devices at various stages of development. The catheter-based MitraClip Mitral Valve Repair System from Abbott Vascular is one of the only percutaneous devices for which there is any significant clinical-trial data. More than 3000 patients have been treated with the device (the majority in Europe) in various trials. Post-procedure recovery is typically one to three days.
However, the National Institute for Health and Clinical Excellence (NICE) (1) published its reservations in 2010 (IPG309) concluding that the data was insufficient for its routine recommendation and that the device procedure should only be used in the context of research. NICE advised that patient selection and treatment must be undertaken by specialist units that include an interventional cardiologist with expertise in echocardiography and a cardiac surgeon. NICE were to review their guidance on publication of further evidence.
Comment
Questions
A visit to YouTube demonstrates how the procedure is less invasive, most certainly from a patient’s perspective. Will this factor alone (as may have been the case with TAVI) result in patients outside the traditional criteria, lobbying for or accepting a procedure which is potentially higher-risk, more costly and which offers less certain long-term outcomes than gold standard surgery?
Furthermore, in industrialised countries, in particular, should governments intervene with campaigns that educate patients to resist pseudo ‘quick-fixes’ and prioritise slower post-surgery recovery for a better outcome, in the longer-term? Looking ahead, could the economics of percutaneous mitral valve repair/replacement herald a groundswell from the health economists for continuation of valve surgery for patients outside the high-risk category?
The European Association of Cardio Thoracic Surgery annual meeting takes place this month (27-31 October). One of the areas that the programme will address is percutaneous mitral valve repair for mitral regurgitation.
User comments: Percutaneous Mitral Valve Leaflet Repair for Mitral Regurgitation - Not Why, But Who?
- 1
- 1
(1) NICE IPG309 Percutaneous mitral valve leaflet repair for mitral regurgitation.