Cerebral Protection During MitraClip Implantation: Initial Experience at 2 Centers

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• 作者：Christian Frerker ; MD^&lowast ; ; ^{c.frerker@asklepios.com" class="auth_mail" title="E-mail the corresponding author} ; Michael Schlü ; ter ; PhD^&dagger ; ; Oscar D. Sanchez ; MD^&Dagger ; ; Sebastian Reith ; MD^&sect ; ; Maria E. Romero ; MD^&Dagger ; ; Elena Ladich ; MD^&Dagger ; ; Jö ; rg Schrö ; der ; MD^&sect ; ; Tobias Schmidt ; MD^&lowast ; ; Felix Kreidel ; MD^&lowast ; ; Michael Joner ; MD^&Dagger ; ; Renu Virmani ; MD^&Dagger ; ; Karl-Heinz Kuck ; MD^&lowast ;
• 关键词：cerebral protection ; embolization ; MitraClip ; mitral regurgitation ; transcatheter mitral valve repair
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：25 January 2016
• 年：2016
• 卷：9
• 期：2
• 页码：171-179
• 全文大小：1644 K

文摘

This study sought to assess the feasibility and safety of using a filter-based cerebral protection system (CPS) during MitraClip implantation and to report on the histopathologic analysis of the captured debris.

absSec_2">Background

abspara0015">Stroke is one of the serious adverse events associated with MitraClip therapy.

absSec_3">Methods

abspara0020">Between July 2014 and March 2015, 14 surgical high-risk patients (age 75 ± 7 years; 7 men; median logistic EuroSCORE 21%) underwent MitraClip implantation employing cerebral protection with a dual embolic filter system. All patients had severe mitral regurgitation of predominantly functional origin.

absSec_4">Results

abspara0025">All procedures were successfully completed for both CPS deployment/retrieval and MitraClip implantation. A total of 28 filters (2 from each patient) were analyzed. Microscopically, debris was identified in all 14 patients. The most common tissue types were acute thrombus and small fragments of foreign material, which were found in 12 patients (85.7%) each. Organizing thrombus was present in 4 patients (28.6%), valve tissue and/or superficial atrial wall tissue in 9 patients (64.3%), and fragments of myocardium in 2 patients (14.3%). No transient ischemic attacks, strokes, or deaths occurred peri-procedurally or during a median follow-up interval of 8.4 months.

absSec_5">Conclusions

abspara0030">In this small study of patients undergoing MitraClip treatment with cerebral protection, embolic debris potentially conducive to cerebrovascular events was found in all patients. Debris was composed most often of acute thrombus, foreign material likely originating from the hydrophilic device coating, and valve/atrial wall tissue. Further studies are warranted to assess the impact of cerebral protection on the incidence of cerebrovascular events after MitraClip therapy.