Mitral Regurgitation
Conditions
Keywords
MR, Mitral Regurgitation, MitraClip
Brief summary
The MitraClip System is the first commercially available catheter-based option for the treatment of MR. The MitraClip System was developed as an alternate percutaneous technology which may serve as a viable therapeutic option for open-heart surgery. Treatment with the MitraClip device allows patients to undergo a less invasive procedure that can mechanistically reduce MR and allow for improved quality of life. The MitraClip procedure is performed under general anesthesia without the use of a heart-lung machine, with recovery typically lasting two to three days.
Detailed description
Mitral regurgitation (MR) is the most common heart valve condition in the world. MR occurs when the mitral valve does not close properly, allowing blood to leak back into the upper chamber of the heart. As a result, the heart may try to pump harder in order to compensate for the decrease in blood flow to the rest of the body. Patients with severe MR suffer from debilitating symptoms such as shortness of breath, heart palpitations, lightheadedness, and fatigue. These patients are at risk of poor quality of life, marked limitation in activity, repeated heart failure hospitalizations, and increased mortality. Chronic severe MR is often associated with heart failure and can lead to death if left untreated. While mitral valve repair or replacement surgery is currently regarded as standard of care, many patients with clinically significant MR are at an unacceptable risk of morbidity and mortality and are therefore not appropriate surgical candidates. To optimize afterload reduction and treatment of fluid load, these patients are often treated with medical management (i.e., beta blockers, ACE inhibitors, angiotensin II receptor blockers) which may relieve MR symptoms, but does not address the underlying cause of the condition. As a result, a significant portion of patients treated medically continue to progress to heart failure and experience an increasingly debilitating quality of life. A significant unmet clinical need thus exists for the treatment of moderate-to-severe and severe MR in high surgical risk patients. The MitraClip System has been in clinical use for treatment of significant MR since 2003. The MitraClip System received CE (Conformité Européenne) Mark for both DMR and FMR indications in March 2008 and was approved by FDA for DMR indication in October 2013 and for FMR indication in March 2019. The system is approved for use in more than 102 countries or regions worldwide. More than 100,000 patients have undergone the MitraClip procedure worldwide. On June 15, 2020, the MitraClip System has been approved for clinical use in China.
Interventions
DEVICEMitraClip procedure
MitraClip procedure with MitraClip NTR System or MitraClip XTR System
Sponsors
Abbott Medical Devices
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subjects is eligible to receive the MitraClip per the current approved MitraClip System IFU. (If any update or amendment on the IFU, the latest version of IFU shall be followed.) 2. Subject is 18 years-old or above. 3. Subjects who give consent for study procedure.
Exclusion criteria
1. Subject cannot tolerate procedural anticoagulation or anti-platelet regimen. 2. Subject with active endocarditis of mitral valve. 3. Subject with rheumatic mitral valve disease. 4. Subject with echocardiographic evidence of intracardiac, IVC or femoral venous thrombus. 5. Subject is unlikely to survive the protocol follow up period of 12-months after device implant. 6. Subject has insufficient or lost ability to maintain their will and rights. 7. Subject is illiterate. 8. Pregnant or nursing subjects and those who plan pregnancy during the study follow-up period 9. Subject participates in another clinical study that may impact the follow-up or results of this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Acute Procedural Success (APS) | Discharge/30days | APS is defined as successful implantation of the MitraClip device(s) with resulting MR severity of 2+ or less as determined by the ECL assessment of a discharge echocardiogram (30-day echocardiogram will be used if discharge echocardiogram is unavailable or uninterpretable). |
| Percentage of Participants With Freedom From Major Adverse Event (MAE) | 30 days | A Major Adverse Event (MAE) was determined as the composite of death, stroke, myocardial infarction (MI), renal failure, and non-elective cardiovascular surgery for device- or procedure-related adverse events occurring after the femoral vein puncture for transseptal access. |
Countries
China
Participant flow
Recruitment details
A total 51 subjects were enrolled across five investigational sites between December 6, 2021, and April 15th, 2024 and follow-up at discharge, 30 days and 1 year.
Participants by arm
| Arm | Count |
|---|---|
| MitraClip Subject will receive MitraClip procedure with MitraClip NTR System or MitraClip XTR System. | 51 |
| Total | 51 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Death | 1 |
| Overall Study | Missed visit | 2 |
Baseline characteristics
| Characteristic | MitraClip | — |
|---|---|---|
| Age, Continuous | 72.0 years STANDARD_DEVIATION 7.7 | — |
| Body Mass Index | 22.6 kg/m² STANDARD_DEVIATION 4.1 | — |
| Diastolic Blood Pressure | 69.9 mmHg STANDARD_DEVIATION 11.3 | — |
| Heart Rate | 74.1 beats per minute STANDARD_DEVIATION 12.7 | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Region of Enrollment China | 51 participants | — |
| Sex: Female, Male Female | 25 Participants | — |
| Sex: Female, Male Male | 26 Participants | — |
| Systolic Blood Pressure | 120.2 mmHg STANDARD_DEVIATION 19.7 | — |
| Weight | 60.2 kg STANDARD_DEVIATION 13.8 | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 1 / 51 |
| other Total, other adverse events | 25 / 51 |
| serious Total, serious adverse events | 16 / 51 |
Outcome results
Primary
Percentage of Participants With Acute Procedural Success (APS)
APS is defined as successful implantation of the MitraClip device(s) with resulting MR severity of 2+ or less as determined by the ECL assessment of a discharge echocardiogram (30-day echocardiogram will be used if discharge echocardiogram is unavailable or uninterpretable).
Time frame: Discharge/30days
Population: The analysis population included all eligible and consented subjects implanted with a MitraClip device. The TTE images at discharge and 30 days were not evaluable by the echo core lab in 2 subjects, hence APS was evaluable for 49 subjects
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MitraClip | Percentage of Participants With Acute Procedural Success (APS) | 93.9 percentage of participants |
Primary
Percentage of Participants With Freedom From Major Adverse Event (MAE)
A Major Adverse Event (MAE) was determined as the composite of death, stroke, myocardial infarction (MI), renal failure, and non-elective cardiovascular surgery for device- or procedure-related adverse events occurring after the femoral vein puncture for transseptal access.
Time frame: 30 days
Population: The analysis population included all eligible and consented subjects implanted with a MitraClip device.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MitraClip | Percentage of Participants With Freedom From Major Adverse Event (MAE) | 100.0 percentage of participants |