Efetividade do MitraClip no tratamento da insuficiência mitral em pacientes idosos
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Publicado
Mar 31, 2025
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Resumo
Objetivo: Avaliar a efetividade do reparo transcateter com o dispositivo MitraClip no tratamento da insuficiência mitral em pacientes idosos. Métodos: Trata-se de uma revisão integrativa de literatura realizada por meio da busca nas bases de dados PubMed e Cochrane Library. Após aplicação dos critérios de elegibilidade, 34 artigos foram selecionados. Resultados: O uso do MitraClip está associado ao aumento na expectativa e na qualidade de vida dos pacientes com regurgitação mitral. Ressalta-se que essa tecnologia é uma opção financeira viável em comparação ao custo da terapia medicamentosa, além de ser considerada a melhor alternativa em pacientes nos quais o reparo com a cirurgia aberta da valva mitral é impossibilitado. O MitraClip demonstrou diminuição da regurgitação mitral residual, poucas complicações e baixa mortalidade pelo procedimento. Considerações finais: Considera-se que o MitraClip é uma estratégia terapêutica eficaz para pacientes idosos, tendo em vista que a maioria dos pacientes apresenta alto risco para a cirurgia aberta da valva mitral. Deve-se, entretanto, prescrever seu uso apenas a pacientes não elegíveis à cirurgia aberta. Assim, o uso do MitraClip deve apresentar indicação clínica criteriosa.
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Como Citar
LinharesG. P. A., CotaR. B., TavaresE. S., CostaR. V. S., RodriguesD. de S., MoreiraA. F., & IoccaD. C. (2025). Efetividade do MitraClip no tratamento da insuficiência mitral em pacientes idosos. Revista Eletrônica Acervo Saúde, 25, e19588. https://doi.org/10.25248/reas.e19588.2025
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Revisão Bibliográfica
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Referências
1. AILAWADI G, et al. One-Year Outcomes After MitraClip for Functional Mitral Regurgitation. Circulation, 2019; 139(1): 37–47.
2. ALLAHAM H, et al. Outcomes of percutaneous mitral valve repair in systolic versus diastolic congestive heart failure. Cardiovascular revascularization medicine: including molecular interventions, 2021; 28: 39–41.
3. ARNOLD SV, et al. Health Status Changes and Outcomes in Patients With Heart Failure and Mitral Regurgitation: COAPT Trial. Journal of the American College of Cardiology, 2020; 75(17): 2099–2106.
4. BARON SJ, et al. Cost-Effectiveness of Transcatheter Mitral Valve Repair Versus Medical Therapy in Patients With Heart Failure and Secondary Mitral Regurgitation. Circulation, 2019; 140(23): 1881–1891.
5. BENITO‐GONZÁLEZ T, et al. MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation. ESC heart failure, 2019: 6(4): 867–873.
6. BUZZATTI N, et al. Transcatheter or surgical repair for degenerative mitral regurgitation in elderly patients: A propensity-weighted analysis. The Journal of Thoracic and Cardiovascular Surgery, 2019; 158(1): 86-941.
7. CHAKRAVARTY T, et al. Transcatheter Edge-to-Edge Mitral Valve Repair With the MitraClip G4 System. Cardiovascular interventions, 2020; 13(20): 2402–2414.
8. CHAUDHARI SS e MANI BC. Mitral Valve Insufficiency. Treasure Island: Statpearls Publishing, 2023; 23.
9. CHEN W, et al. Usefulness of Age (≥85 Years) and Residual Mitral Regurgitation (>1+/4+) for the Prediction of Adverse Outcomes in Patients Receiving the MitraClip. The American journal of cardiology, 2019; 124(9): 1449–1453.
10. CHRISTIDI A, et al. Two year outcome in nonagenarians undergoing percutaneous mitral valve repair. ESC Heart Fail, 2021; 8(1): 577-585.
11. CIMINO S, et al. Mid-term repair durability after MitraClip implantation in patients with functional mitral regurgitation. Journal of cardiovascular medicine (Hagerstown, Md.), 2019; 20(10): 701–708.
12. DOLDI PM, et al. Percutaneous edge‐to‐edge repair of severe mitral regurgitation using the MitraClip XTR versus NTR system. Clinical Cardiology, 2021; 44(5): 708–714.
13. DOUEDI S e DOUEDI H. Mitral Regurgitation. Treasure Island: StatPearls Publishing, 2024; 49.
14. GARCIA S, et al. Percutaneous Mitral Valve Repair With MitraClip in Inoperable Patients With Severe Mitral Regurgitation Complicated by Cardiogenic Shock. Clinical cardiology, 2021; 44(5): 708–714.
15. GIORDANO A, et al. Characteristics and outcomes of MitraClip in octogenarians: Evidence from 1853 patients in the GIOTTO registry. International journal of cardiology, 2021; 342: 65–71.
16. KAR S, et al. Five-year outcomes of transcatheter reduction of significant mitral regurgitation in high-surgical-risk patients. Heart (British Cardiac Society), 2019; 105(21): 1622–1628.
17. KESSLER M, et al. Predictors of rehospitalization after percutaneous edge-to-edge mitral valve repair by MitraClip implantation. European journal of heart failure, 2019; 21(2): 182–192.
18. KOSMIDOU I, et al. Transcatheter Mitral Valve Repair in Patients With and Without Cardiac Resynchronization Therapy. Circulation Heart failure, 2020; 13(11): 7293.
19. LEDWOCH J, et al. Impact of transcatheter mitral valve repair using MitraClip on right ventricular remodeling. The international journal of cardiovascular imaging, 2020; 36(5): 811–819.
20. LEE CW, et al. Feasibility of the transcatheter mitral valve repair for patients with severe mitral regurgitation and endangered heart failure. Journal of the Formosan Medical Association, 2021; 120: 452–459.
21. MACK MJ, et al. 3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With Heart Failure. Journal of the American College of Cardiology, 2021; 77(8): 1029–1040.
22. MALIK U, et al. Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation. JACC. Cardiovascular interventions, 2020; 13(20): 2331–2341.
23. MKALALUH S, et al. Failed MitraClip therapy: surgical revision in high-risk patients. Journal of cardiothoracic surgery, 2019; 14(1): 75.
24. MUNAFÒ AR, et al. 2-year outcomes of MitraClip as a bridge to heart transplantation: The international MitraBridge registry. International journal of cardiology, 2023; 390: 131139.
25. OSTOVAR R, et al. MitraClip: a word of caution regarding an all too liberal indication and delayed referral to surgery in case of failure. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery, 2021; 59(4): 887–893.
26. ÖZTÜRK C, et al. Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions, 2020; 96(3): 678–684.
27. ÖZTÜRK C, et al. Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve. Cardiology journal, 2021; 28(2): 215–222.
28. PAULUS MG, et al. Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation. PloS one, 2020; 15(5): 232817.
29. RADER F, et al. Mitral Valve Surgery After Failed MitraClip: A Single-Center Experience. Journal of invasive cardiology, 2021; 33(4): 236–243.
30. REICHART D, et al. The impact of residual mitral regurgitation after MitraClip therapy in functional mitral regurgitation. European journal of heart failure, 2020; 22(10): 1840–1848.
31. RUBBIO AP, et al. Transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation: insights from the multi-center MITRA-TUNE registry. International journal of cardiology, 2022; 349: 39–45.
32. SANCHIS L, et al. Safety and outcomes of MitraClip implantation in functional mitral regurgitation according to degree of left ventricular dysfunction. Revista espanola de cardiologia (English ed.), 2019; 73(7): 530–535.
33. SCHNITZLER K, et al. Complications Following MitraClip Implantation. Current cardiology reports, 2021; 23(9): 131.
34. SHERIF MA, et al. MitraClip step by step; how to simplify the procedure. Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2017; 25(2): 125–130.
35. SONG C, et al. Age-Related Outcomes After Transcatheter Mitral Valve Repair in Patients With Heart Failure. JACC. Cardiovascular interventions, 2022; 15(4): 397–407.
36. TANAKA T, et al. Transcatheter Edge-to-Edge Repair for Atrial Secondary Mitral Regurgitation. JACC. Cardiovascular interventions, 2022; 15(17): 1731–1740.
37. ULLAH W, et al. Outcomes of open mitral valve replacement versus Transcatheter mitral valve repair; insight from the National Inpatient Sample Database. International journal of cardiology. Heart & vasculature, 2020; 28: 100540.
38. VILLABLANCA PA, et al. Sex-Based Differences in Outcomes With Percutaneous Transcatheter Repair of Mitral Regurgitation With the MitraClip System: Transcatheter Valve Therapy Registry From 2011 to 2017. Circulation. Cardiovascular interventions, 2021; 14(11): 9374.
2. ALLAHAM H, et al. Outcomes of percutaneous mitral valve repair in systolic versus diastolic congestive heart failure. Cardiovascular revascularization medicine: including molecular interventions, 2021; 28: 39–41.
3. ARNOLD SV, et al. Health Status Changes and Outcomes in Patients With Heart Failure and Mitral Regurgitation: COAPT Trial. Journal of the American College of Cardiology, 2020; 75(17): 2099–2106.
4. BARON SJ, et al. Cost-Effectiveness of Transcatheter Mitral Valve Repair Versus Medical Therapy in Patients With Heart Failure and Secondary Mitral Regurgitation. Circulation, 2019; 140(23): 1881–1891.
5. BENITO‐GONZÁLEZ T, et al. MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation. ESC heart failure, 2019: 6(4): 867–873.
6. BUZZATTI N, et al. Transcatheter or surgical repair for degenerative mitral regurgitation in elderly patients: A propensity-weighted analysis. The Journal of Thoracic and Cardiovascular Surgery, 2019; 158(1): 86-941.
7. CHAKRAVARTY T, et al. Transcatheter Edge-to-Edge Mitral Valve Repair With the MitraClip G4 System. Cardiovascular interventions, 2020; 13(20): 2402–2414.
8. CHAUDHARI SS e MANI BC. Mitral Valve Insufficiency. Treasure Island: Statpearls Publishing, 2023; 23.
9. CHEN W, et al. Usefulness of Age (≥85 Years) and Residual Mitral Regurgitation (>1+/4+) for the Prediction of Adverse Outcomes in Patients Receiving the MitraClip. The American journal of cardiology, 2019; 124(9): 1449–1453.
10. CHRISTIDI A, et al. Two year outcome in nonagenarians undergoing percutaneous mitral valve repair. ESC Heart Fail, 2021; 8(1): 577-585.
11. CIMINO S, et al. Mid-term repair durability after MitraClip implantation in patients with functional mitral regurgitation. Journal of cardiovascular medicine (Hagerstown, Md.), 2019; 20(10): 701–708.
12. DOLDI PM, et al. Percutaneous edge‐to‐edge repair of severe mitral regurgitation using the MitraClip XTR versus NTR system. Clinical Cardiology, 2021; 44(5): 708–714.
13. DOUEDI S e DOUEDI H. Mitral Regurgitation. Treasure Island: StatPearls Publishing, 2024; 49.
14. GARCIA S, et al. Percutaneous Mitral Valve Repair With MitraClip in Inoperable Patients With Severe Mitral Regurgitation Complicated by Cardiogenic Shock. Clinical cardiology, 2021; 44(5): 708–714.
15. GIORDANO A, et al. Characteristics and outcomes of MitraClip in octogenarians: Evidence from 1853 patients in the GIOTTO registry. International journal of cardiology, 2021; 342: 65–71.
16. KAR S, et al. Five-year outcomes of transcatheter reduction of significant mitral regurgitation in high-surgical-risk patients. Heart (British Cardiac Society), 2019; 105(21): 1622–1628.
17. KESSLER M, et al. Predictors of rehospitalization after percutaneous edge-to-edge mitral valve repair by MitraClip implantation. European journal of heart failure, 2019; 21(2): 182–192.
18. KOSMIDOU I, et al. Transcatheter Mitral Valve Repair in Patients With and Without Cardiac Resynchronization Therapy. Circulation Heart failure, 2020; 13(11): 7293.
19. LEDWOCH J, et al. Impact of transcatheter mitral valve repair using MitraClip on right ventricular remodeling. The international journal of cardiovascular imaging, 2020; 36(5): 811–819.
20. LEE CW, et al. Feasibility of the transcatheter mitral valve repair for patients with severe mitral regurgitation and endangered heart failure. Journal of the Formosan Medical Association, 2021; 120: 452–459.
21. MACK MJ, et al. 3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With Heart Failure. Journal of the American College of Cardiology, 2021; 77(8): 1029–1040.
22. MALIK U, et al. Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation. JACC. Cardiovascular interventions, 2020; 13(20): 2331–2341.
23. MKALALUH S, et al. Failed MitraClip therapy: surgical revision in high-risk patients. Journal of cardiothoracic surgery, 2019; 14(1): 75.
24. MUNAFÒ AR, et al. 2-year outcomes of MitraClip as a bridge to heart transplantation: The international MitraBridge registry. International journal of cardiology, 2023; 390: 131139.
25. OSTOVAR R, et al. MitraClip: a word of caution regarding an all too liberal indication and delayed referral to surgery in case of failure. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery, 2021; 59(4): 887–893.
26. ÖZTÜRK C, et al. Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions, 2020; 96(3): 678–684.
27. ÖZTÜRK C, et al. Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve. Cardiology journal, 2021; 28(2): 215–222.
28. PAULUS MG, et al. Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation. PloS one, 2020; 15(5): 232817.
29. RADER F, et al. Mitral Valve Surgery After Failed MitraClip: A Single-Center Experience. Journal of invasive cardiology, 2021; 33(4): 236–243.
30. REICHART D, et al. The impact of residual mitral regurgitation after MitraClip therapy in functional mitral regurgitation. European journal of heart failure, 2020; 22(10): 1840–1848.
31. RUBBIO AP, et al. Transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation: insights from the multi-center MITRA-TUNE registry. International journal of cardiology, 2022; 349: 39–45.
32. SANCHIS L, et al. Safety and outcomes of MitraClip implantation in functional mitral regurgitation according to degree of left ventricular dysfunction. Revista espanola de cardiologia (English ed.), 2019; 73(7): 530–535.
33. SCHNITZLER K, et al. Complications Following MitraClip Implantation. Current cardiology reports, 2021; 23(9): 131.
34. SHERIF MA, et al. MitraClip step by step; how to simplify the procedure. Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2017; 25(2): 125–130.
35. SONG C, et al. Age-Related Outcomes After Transcatheter Mitral Valve Repair in Patients With Heart Failure. JACC. Cardiovascular interventions, 2022; 15(4): 397–407.
36. TANAKA T, et al. Transcatheter Edge-to-Edge Repair for Atrial Secondary Mitral Regurgitation. JACC. Cardiovascular interventions, 2022; 15(17): 1731–1740.
37. ULLAH W, et al. Outcomes of open mitral valve replacement versus Transcatheter mitral valve repair; insight from the National Inpatient Sample Database. International journal of cardiology. Heart & vasculature, 2020; 28: 100540.
38. VILLABLANCA PA, et al. Sex-Based Differences in Outcomes With Percutaneous Transcatheter Repair of Mitral Regurgitation With the MitraClip System: Transcatheter Valve Therapy Registry From 2011 to 2017. Circulation. Cardiovascular interventions, 2021; 14(11): 9374.