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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESurgical approaches for degenerative or functional mitral regurgitation (MR) continue to have limitations and not all patients are appropriate surgical candidates. This article discusses the use of percutaneous mitral valve repair for functional MR using the MitraClip Device and the results from their initial experience in Egypt.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESurgical approaches for degenerative or functional mitral regurgitation (MR) continue to have limitations and not all patients are appropriate surgical candidates. Hazem Khamis, MD, October 6 University Hospital, Giza, Egypt, described the use of percutaneous mitral valve repair for functional MR using the MitraClip Device and the results from their initial experience in Egypt.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThis percutaneous device delivers two stitches into the mitral valve leaflets that approximate the two leaflets in a manner similar to that of the surgical Alfieri technique. The MitraClip procedure requires sufficient leaflet tissue in the mitral valve for mechanical coaptation, with a flail gap \u0026lt;10 mm, a flail width \u0026lt;15 mm, and a mitral area \u22654.0 cm. To use the MitralClip, the etiology of the regurgitation cannot be due to either rheumatic fever or infective endocarditis. The MitraClip is approved in some European and Asian countries, but is available for use only within clinical trials in the United States.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn 78 high-risk surgical patients (\u226512% predicted mortality) with extensive comorbidities, the MitraClip device was shown to reduce MR, improve symptoms (functional status and quality of life), and prevent ventricular reverse remodeling through 1 year, according to results from the EVEREST II High Risk Study [Whitlow PL et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2012]. Similar clinical benefits were found in the ACCESS EU trial of functional MR in patients with extensive comorbidities [Maisano F et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe PERMIT-CARE prospective survey in 51 symptomatic patients who were not successfully treated with cardiac resynchronization therapy (CRT) in seven European centers showed there was significant improvement in NYHA class and MR after MitraClip implantation [Auricchio A et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EProf. Khamis stressed the importance of the multidisciplinary team for the MitraClip approach, which discusses every potential patient. The team includes the interventional cardiologist, cardiac anesthetist, echocardiogram specialists, laboratory staff, and nursing staff who were given specialized training. All patients undergo a preprocedural transthoracic echocardiogram and transesophageal echocardiogram (TEE).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAt their institution, Prof. Khamis and colleagues have treated five patients, all of whom had functional MR. The baseline demographics and comorbidities of these patients are summarized in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. One patient was treated with two MitraClips, and the others with a single clip. There were no procedural major adverse cardiac events. The device performance was good, without any occurrence of embolization, fracture, erosion, or migration of the percutaneous device, or single leaflet device attachment. At 1 month, all of the patients reported a marked improvement in symptoms and in exercise capacity. At 30 days, only one safety endpoint had occurred, which was a deep wound infection.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EBased on the results in the first five patients treated in Egypt, as well as those who have been treated in other parts of the world, percutaneous MV repair with the MitraClip device appears both safe and feasible. However, Prof. Khamis stated there is a steep learning curve, and understanding the MV anatomy and the TEE images is essential to proper device delivery. Furthermore, he stated there is a definite need for the development of percutaneous treatment options for MR in order to treat patients who are not candidates for current surgical treatments.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13348\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13348\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13348\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EBaseline Demographics and Comorbidities\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/7\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznta1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznta1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}