title: In-hospital outcome of patients with severe mitral valve regurgitation classified as inoperable and treated with the MitraClip® device.
abstract: BACKGROUND
  To evaluate the short-term outcome of patients predominantly at high risk treated with the MitraClip® device for severe mitral valve regurgitation (MR) using one or more clips.
  
  
  METHODS
  We prospectively analyzed patients with highly symptomatic MR classified as inoperable (logistic EuroSCORE 24.16 ± 13.64%; STS-score 29.9 ± 14.5%) but subject to mitral valve repair with MitraClip® between May 2010 and January 2011. Thirty-three consecutive patients (57.6% male; age 77.8 ± 6.7 years) were enrolled and treated with either 1 (n = 7; 21.2%), 2 (n = 20; 60.6%), 3 (n = 4; 12.1%), or 4 (n = 2, 6.1%) clips. Grading of MR was performed by two-dimensional transesophageal echocardiography (2D-TEE) prior to TEE-guided clipping and before discharge.
  
  
  RESULTS
  MR was classified as functional in 23 (69.7%) and organic in 10 (30.3%) of the patients with MR-grade ≥ 3+ in 32 (97%) and = 4 in 1 patients (3%) before repair. Reduction in MR grade to grade ≤1+ was achieved in 81.7% and to 2 in 12.1% (P = 0.00072). Invasive pulmonary artery systolic pressure (PAPsyst) and pulmonary capillary wedge pressure (PCWP) v-wave decreased from 59.2 ± 18.6 to 46.9 ± 15.3 mmHg (P = 0.00014) and 21.2 ± 6.7 to 8.0 ± 3.3 mmHg (P = 0.0093), respectively, as measured immediately after clipping. Functional NYHA class improved from mean 3 (range 3 [90.9%] to 4 [9.1%]) to 2 in 84.9% (P = 0.00081) as obtained at discharge.
  
  
  CONCLUSIONS
  Mitral valve repair with MitraClip® using multiple clips is appropriate and safe in unselected patients resulting in reduced MR with positive impact on short-term functional capacity.
authors.affiliation: University Medicine Rostock, Heart Center Rostock (Cardiology), Rostock, Germany.
authors.forename: Dimitar
authors.initials: D
authors.lastname: Divchev
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.forename: Liliya
authors.initials: L
authors.lastname: Paranskaya
authors.forename: Henrik
authors.initials: H
authors.lastname: Schneider
authors.forename: Tim
authors.initials: T
authors.lastname: Rehders
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Gökmen
authors.initials: G
authors.lastname: Turan
authors.forename: Cem Hakan
authors.initials: CH
authors.lastname: Turan
authors.forename: Gustav
authors.initials: G
authors.lastname: Steinhoff
authors.forename: Gabriele
authors.initials: G
authors.lastname: Nöldge-Schomburg
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D002407:Catheterization, Swan-Ganz; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000628:therapy*; D019736:Prostheses and Implants; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications