title: Effect of percutaneous mitral repair with the MitraClip device on mitral valve area and gradient.
abstract: OBJECTIVE
  Percutaneous repair of mitral regurgitation (MR) by leaflet apposition using a clip deployed via transseptal catheterisation is undergoing evaluation.
  
  
  RESULTS
  In order to detect the potential for clinically significant left ventricular inflow obstruction after percutaneous repair, we measured mitral valve area (MVA) and mean transmitral gradient (MVG) echocardiographically in 96 patients implanted with a clip followed for up to 24 months. By planimetry, the mean MVA decreased from 6.0 +/- 1.3 cm2 to 3.6 +/- 1.2 cm2 (p < 0.05) (range 1.9 to 7.6 cm2) after clip placement, and remained unchanged after 24 months of follow-up (3.5 +/- 0.8 cm2). The mean MVG increased after clip placement from 1.7 +/- 0.9 mmHg to 4.1 +/- 2.2 mmHg (p < 0.05), and did not increase further to 24 months (3.8 +/- 1.9 mmHg). There were no differences in MVA or MVG between patients who received 1-clip (69%) and those receiving 2-clips (31%). Patients with functional MR (23%) had a slightly smaller MVA, both at baseline and after clip placement, but did not differ from degenerative MR patients at later follow-up. After 2 years of follow-up, no patient required surgery for LV inflow obstruction.
  
  
  CONCLUSIONS
  Mitral repair with the MitraClip device for MR decreases MVA without significant mitral obstruction. After 2 years of follow-up, no patient required surgery for LV inflow obstruction, and these results were not influenced by the use of more than 1 clip or the aetiology of MR.
authors.affiliation: Interventional Cardiology and Cardiac Catheterization Laboratories, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9038 Gates Building, Philadelphia, PA 19104, USA. howard.herrmann@uphs.upenn.edu
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.forename: Robert
authors.initials: R
authors.lastname: Siegel
authors.forename: Peter
authors.initials: P
authors.lastname: Fail
authors.forename: Catalin
authors.initials: C
authors.lastname: Loghin
authors.forename: Scott
authors.initials: S
authors.lastname: Lim
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hahn
authors.forename: Jason H
authors.initials: JH
authors.lastname: Rogers
authors.forename: William J
authors.initials: WJ
authors.lastname: Bommer
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: Andrew
authors.initials: A
authors.lastname: Berke
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.forename: Paul
authors.initials: P
authors.lastname: Kramer
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.forename: Don
authors.initials: D
authors.lastname: Glower
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D012042:Registries; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology