Percutaneous Mitral Valve Repair in Pediatric Patients.
Haregu F, Wong N, McCulloch M, Lim DS.Pediatr Cardiol. 2023 Dec 27. doi: 10.1007/s00246-023-03387-4. Online ahead of print.PMID: 38150041
Take Home Points:
- TEER is feasible in pediatric patients of adequate size with severe MR and high surgical risk.
- Further studies are needed to understand long-term implications of TEER in the pediatric population.
Commentary from Dr. Arash Salavitabar (Ann Arbor, MI, USA), section editor of Congenital Heart Disease Interventions Journal Watch:
The authors report on a case series of 4 pediatric patients who underwent transcatheter edge-to-edge repair (TEER) to treat severe mitral regurgitation (MR). The patients were 6-17 years of age and as small as 19 kg, with cardiac diagnoses ranging from heart transplantation following single ventricle palliation, dilated cardiomyopathy and congenital mitral valve dysplasia with degenerative MR. The MitraClip device (Abbott Vascular, Santa Clara, CA) was utilized in all cases. All patients were deemed to be high risk or non-surgical candidates and all cases resulted in a significant improvement in MR.
The authors described the MitraClip, which has delivery system that consists of a steerable guide catheter that is 24-French at the skin and 22-French as it crosses the interatrial septum. The large profile was thought to be a likely limitation in its utility in patients under 15-20 kg. The MitraClip device grasps between the anterior and posterior MV leaflets, which brings them together to reduce the regurgitant orifice area.
Though there remains a paucity of long-term data on the durability of TEER’s efficacy, particularly when considering younger patients who are surgical candidates, TEER has the potential to reduce heart failure symptoms and degree of MR. Pre-procedural planning is important, with due consideration to patient size and vascular access.
