On April 22, 2021, the valve intervention team from Department of Cardiovascular Medicine of the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) successfully completed two cases of minimally invasive mitral valve repair by using the MitraClip system, and the hospital becomes the 7th medical center in Chinese mainland to carry out percutaneous mitral valve clipping. It is the first clinical practice in western China to apply MitraClip system after the system is available in China.
The first male patient, aged 70-year-old, was diagnosed with valvular heart disease, mitral chordae tendineae rupture complicated with severe mitral insufficiency, NYHA grade II, atrial fibrillation, grade I hypertension (extremely high risk) and coronary atherosclerotic cardiomyopathy. The second 67-year-old female patient was diagnosed with valvular heart disease, mitral valve prolapse complicated with severe mitral insufficiency, severe closure insufficiency of tricuspid valve and NYHA grade II.
Both two patients developed severe mitral insufficiency. After discussion, the heart team considered that both two patients met the indications for mitral valve intervention. However, the risk of traditional open surgery for mitral valve repair or replacement is relatively high. After comprehensive evaluation, the team led by Professor Yuan Zuyi and Professor Han Ke was determined to perform percutaneous mitral valve clipping by using the MitraClip system. Preoperatively, the surgery team delivered in-depth discussion with Professor Song Sixian from Taipei Veterans General Hospital and jointly determined the optimal surgical strategy. Intraoperatively, Professor Song Sixian also provided technical support via video connection. The interventional surgery team led by Professor Yuan Zuyi and Professor Han Ke performed the operation. Professor Wang Shun from Department of Ultrasound was responsible for intraoperative echocardiography guidance.
Under the guidance of transesophageal echocardiography and X-ray, the MitraClip valve clip was successfully delivered to the center of the junction between anterior and posterior leaflets of mitral valve through femoral vein approach under general anesthesia, and the anterior leaflet A2 and posterior leaflet P2 of mitral valve were successfully captured. After the leaflets were firmly clipped confirmed by repeated echocardiography, the effective clipping length was measured as 9mm and 7mm for two patients. The estimated regurgitation volume was mitigated to mild and a small amount. Then, the valve clip was released. Echocardiography confirmed that the position and function of the valve clip were excellent, and the estimated regurgitation volume was still mild and a small amount, indicating the success of the MitraClip procedure.
MitraClip system for percutaneous interventional surgery is a transcatheter mitral valve device approved for high-risk or inoperable patients with severe mitral insufficiency. The whole surgery can be completed via the femoral vein approach. Consequently, it causes mild trauma and rapid postoperative recovery. Patients can take out-off-bed activities the next day after surgery. MitraClip system has been applied in more than 100,000 cases worldwide, which has been recommended by national guidelines in Europe and the U.S.(IIA indications).The safety of MitraClip procedure has been warranted.
Mou Jianjun, Director of Department of Cardiovascular Medicine, highlighted that the success of the first application of MitraClip procedure in two patients with severe mitral regurgitation in the western region makes a good start. Subsequently, Department of Cardiovascular Medicine will play the leading role of National Cardiovascular Medical Center for Northwest Region and better serve the patients.
