Introduction

The transcatheter edge-to-edge (TEER) procedure is a complex, multi-step procedure that requires advanced skills to achieve optimal outcomes. These skills include a detailed understanding of normal and diseased mitral valve anatomy, imaging with transesophageal echocardiography, and the multiple steps and nuances of delivering and deploying the MitraClip (one or multiple) to the appropriate locations on the mitral valve leaflets. This ebook provides practical knowledge on how to perform the TEER procedure. 

This ebook is divided into three parts utilizing imaging, video clips, and animations, creating an interactive user learning experience:

Part 1: Pre-Procedure Evaluation 

• Basic Evaluation of Mitral Regurgitation
• Patient Selection for Transcatheter Mitral Leaflet Repair
• Imaging Essentials for the Transcatheter Mitral Valve Repair Procedure

Part 2: Transcatheter Mitral Edge-to-Edge Leaflet Repair Device Overview 

• A User’s Guide to the MitraClip Device
• Procedural Strategy and Planning – Primary MR
• Procedural Strategy and Planning – Secondary MR

Part 3: Transcatheter Mitral Leaflet Valve Edge-to-Edge Repair Procedure "Step-by-Step" 

• Procedural Decision-Making Algorithm for TEER
• Vascular Access
• Transseptal Puncture
• Left Atrial Steering, Clip Position, and Trajectory
• Clip Alignment and Entering the Left Ventricle
• Leaflet Grasping and Additional Clips
• Use of Controlled Gripper Actuation
• Evaluation of Iatrogenic ASD and Need for Closure
• Complications: Single Leaflet Device Attachment, Chordal Entanglement, and Embolization
• MitraClip After Surgical Mitral Valve Repair
• Future Directions – Practical Guide to Volumetric Intracardiac Echocardiography-guided MitraClip Implantation

All Authors:

Edris Aman, MD; Anita W. Asgar, MD, MSc, FSCAI; Neil Beri, MD; Lily Chen, MD; Creighton W. Don, MD, PhD, FSCAI; Anique Ducharme, MD, MSc; Patrick Garceau, MD; Mayra E. Guerrero, MD, FSCAI; Rafael Harari, MD; Parasuram Krishnamoorthy, MD; Jamart Laurent, MD; Scott Lim, MD; Georg Burkhard Mackensen, MD, PhD; Rhonda Miyasaka, MD; Paul Ohayon, MD; Nils Perrin, MD; Matthew J. Price, MD, FSCAI; Reza Reyaldeen, MD; Jason H. Rogers, MD, FSCAI; Hirotomo Sato, MD, PhD; Aaron Schelegle, MD, FSCAI; Trevor Simard, MD; Gagan Singh, MD, FSCAI; Nishtha Sodhi, MD, FSCAI; Paul Sorajja, MD, FSCAI; Benjamin Stripe, MD, FSCAI; Gilbert Tang, MD, MBA, FSCAI; and Jonathan J. Yap, MBBS, MCRP, MPH.