ABSTRACT
The Evalve cardiovascular valve repair system consists of a steerable (one plane) guide catheter and a clip delivery system (CDS) which includes a steerable sleeve (two planes), a clip delivery catheter, and a clip (MitraClip™ Evalve, Inc., Menlo Park, CA) (Figures 24.1 and 24.2). The clip is placed on the free edges of the central anterior and posterior mitral leaflet scallops which results in permanent approximation similar to the suture-based, surgical edge-to-edge repair technique.1,2 The CDS has at its tip a detachable clip (Figure 24.2) used to grasp the mitral leaflets from the ventricular side. Once the leaflets are grasped the ‘gripper’ is lowered onto the atrial side of the leaflets and the clip is partially closed, securing the leaflets. Reduction of mitral regurgitation (MR), the establishment of a double orifice, and adequate leaflet insertion within the clip are then evaluated. If these criteria are met, the clip is closed further to reduce MR. Once MR is adequately reduced and there is good insertion of the mitral leaflets into the clip, the clip can be released. If the results of the grasp are not adequate, the ‘gripper’ can be raised, the clip re-opened and other attempts at grasping can be performed after repositioning of the CDS, if needed.
