title: Mitral clip - looking back and moving forward.
abstract: OBJECTIVE
  Guidelines indicate surgical intervention for patients with symptomatic severe mitral regurgitation or signs of left ventricular dilatation or dysfunction. However, many patients do not receive surgery because of age or comorbidities, and have poor outcomes with conservative therapy. Transcatheter mitral repair with MitraClip (Abbott Vascular, IL, USA) has recently emerged as a viable treatment option for high-risk patients with heart failure. This article will review current evidence supporting the use of MitraClip across the spectrum of patient risk and discuss future directions for this technology.
  
  
  RESULTS
  Both randomized and registry studies have demonstrated the efficacy and safety of MitraClip for mitral regurgitation reduction, with significant improvements in functional class and reductions in heart failure hospitalizations. With increasing global experience, a broader scope of patients and diseases can now be successfully treated, ranging from patients with failed surgical annuloplasty rings to those in cardiogenic shock. Ongoing randomized trials will further define the role of MitraClip in the management of heart failure patients with secondary mitral regurgitation.
  
  
  CONCLUSIONS
  MitraClip is a useful therapeutic tool for nonsurgical patients with advanced heart failure and severe mitral regurgitation. Further developments in device design and procedural technique will continue to expand the range of patients who can be treated, with a goal of reducing heart failure hospitalizations and improving quality of life.
authors.affiliation: aDivision of Cardiology, St Michael's Hospital bDivision of Cardiology, Toronto General Hospital, University Health Network cDivision of Cardiac Surgery, Keenan Research Centre for Biomedical Science dLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
authors.forename: Neil P
authors.initials: NP
authors.lastname: Fam
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
mesh_terms: D006333:Heart Failure / Q000150:complications*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D020379:Risk Adjustment; D013525:Surgical Instruments; D016896:Treatment Outcome