Percutaneous edge-to-edge mitral valve repair in high-surgical-risk patients: do we hit the target?
OBJECTIVE
This study sought to assess the feasibility and safety of percutaneous edge-to-edge mitral valve (MV) repair in patients with an unacceptably high operative risk.


BACKGROUND
MV repair for mitral regurgitation (MR) can be accomplished by use of a clip that approximates the free edges of the mitral leaflets.


METHODS
All patients were declined for surgery because of a high logistic EuroSCORE (>20%) or the presence of other specific surgical risk factors. Transthoracic echocardiography was performed before and 6 months after the procedure. Differences in New York Heart Association (NYHA) functional class, quality of life (QoL) using the Minnesota questionnaire, and 6-min walk test (6-MWT) distances were reported.


RESULTS
Fifty-five procedures were performed in 52 patients (69.2% male, age 73.2 ± 10.1 years, logistic EuroSCORE 27.1 ± 17.0%). In 3 patients, partial clip detachment occurred; a second clip was placed successfully. One patient experienced cardiac tamponade. Two patients developed inguinal bleeding, of whom 1 needed surgery. Six patients (11.5%) died during 6-month follow-up (5 patients as a result of progressive heart failure and 1 noncardiac death). The MR grade before repair was ≥3 in 100%; after 6 months, a reduction in MR grade to ≤2 was present in 79% of the patients. Left ventricular (LV) end-diastolic diameter, LV ejection fraction, and systolic pulmonary artery pressure improved significantly. Accompanied improvements in NYHA functional class, QoL index, 6-MWT distances, and log N-terminal pro-B-type natriuretic peptide were observed.


CONCLUSIONS
In a high-risk population, MR reduction can be achieved by percutaneous edge-to-edge valve repair, resulting in LV remodeling with improvement of functional capacity after 6 months.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. b.van.den.branden@antoniusziekenhuis.nl
Ben J L
BJ
Van den Branden
Martin J
MJ
Swaans
Martijn C
MC
Post
Benno J W M
BJ
Rensing
Frank D
FD
Eefting
Wybren
W
Jaarsma
Jan A S
JA
Van der Heyden
D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006305:Health Status Indicators; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D016277:Ventricular Function, Left