Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction.
OBJECTIVE
We sought to assess the feasibility of catheter-based mitral valve repair using the MitraClip system in high-surgical-risk patients with mitral regurgitation (MR) > or =grade 3+.


RESULTS
MitraClip therapy was performed in 51 consecutive patients [73 +/- 10 years; 34 (67%) men] with symptomatic functional [n = 35 (69%)] or organic MR [n = 16 (31%)]. Mean logistic EuroSCORE was 29 +/- 22%; Society of Thoracic Surgeons score was 15 +/- 11. Left ventricular (LV) ejection fraction was 36 +/- 17%. In 35 patients (69%), adverse mitral valve morphology and/or severe LV dysfunction were present. MitraClip implantation was successful in 49 patients (96%). Most patients [n = 34/49 (69%)] were treated with a single clip, whereas 14 patients (29%) received two clips and one patient received three clips. Mean device and fluoroscopy times were 105 +/- 65 min and 44 +/- 28 min, respectively. Procedure-related reduction in MR severity was one grade in 16 patients (31%), two grades in 24 patients (47%), and three grades in 9 patients (18%). Forty-four of the 49 successfully treated patients (90%) showed clinical improvement at discharge [NYHA functional class > or =III in 48 patients (98%) before and 16 patients (33%) after the procedure (P < 0.0001)]. There were no procedure-related major adverse events and no in-hospital mortality.


CONCLUSIONS
Mitral valve repair using the MitraClip system was shown to be feasible in patients at high surgical risk primarily determined by an adverse mitral valve morphology and/or severe LV dysfunction.
Franzen
Olaf
O
Department of General and Interventional Cardiology, University Heart Centre, Hamburg, Germany. owfranzen@gmx.de
Baldus
Stephan
S
Rudolph
Volker
V
Meyer
Sven
S
Knap
Malgorzata
M
Koschyk
Dietmar
D
Treede
Hendrik
H
Barmeyer
Achim
A
Schofer
Joachim
J
Costard-Jäckle
Angelika
A
Schlüter
Michael
M
Reichenspurner
Hermann
H
Meinertz
Thomas
T
D000368:Aged; D000369:Aged, 80 and over; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D013525:Surgical Instruments; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*