title: Percutaneous mitral valve repair with the MitraClip system: perioperative and 1-year follow-up results using standard or multiple clipping strategy.
abstract: OBJECTIVE
  The purpose of this study was to compare outcomes using standard clipping (SC) (one to two clips) or multiple clipping (MC) (more than two clips).
  
  
  BACKGROUND
  MitraClip implantation using MC has been proposed to treat severe mitral regurgitation (MR) in high-risk patients.
  
  
  RESULTS
  A tailored strategy was used implanting as many clips as required to eliminate MR. A total of 85 consecutive patients [78 ± 6 years, 48 men (56.5%) ] with MR (grade 3+ or 4+) were included. EuroSCORE was 24 ± 12 (2.5-56.3) and STS-score 12 ± 7 (1.2-31.2). SC was used in 61 (71.8%) and MC in 24 (28.2%) patients. Patients in MC group had larger mitral valve (MV) annuli (P = 0.025), MV orifice areas (MVOA) (P = 0.01), and MR degree (P = 0.005). Successful clip placement was achieved in 82 patients (96.5%). At discharge, no patient had grade 4+ MR. MR 3+ presented in 4 patients (7.0%) in the SC group and in 1 (4.5%) in the MC group (P = 0.72). There were 3 (3.5%) in-hospital deaths. Follow up (211 ± 173 days, range 4-652) echocardiography confirmed similar MVOA (P = 0.83) and MV gradients (P = 0.54) in the both groups. At linear regression there was no independent correlation between clips number and postoperative MVOA/gradient. One-year survival was 71.1% without difference between groups (P = 0.74).
  
  
  CONCLUSIONS
  Although the hemodynamic and anatomical basis of MR may differ, every procedure should aim at eliminating MR. In some patients this goal can be achieved using MC with minimized risk of MV stenosis if preoperative anatomy/mechanism of MV regurgitation are adequately assessed.
authors: Department of Cardiology, University Hospital, Heart Center, Rostock, Germany.
authors: Liliya
authors: L
authors: Paranskaya
authors: Giuseppe
authors: G
authors: D'Ancona
authors: Ilkay
authors: I
authors: Bozdag-Turan
authors: Ibrahim
authors: I
authors: Akin
authors: Stephan
authors: S
authors: Kische
authors: Gökmen R
authors: GR
authors: Turan
authors: Dimitar
authors: D
authors: Divchev
authors: Tim
authors: T
authors: Rehders
authors: Bernd
authors: B
authors: Westphal
authors: Jochen
authors: J
authors: Schubert
authors: Christoph A
authors: CA
authors: Nienaber
authors: Hüseyin
authors: H
authors: Ince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008946:Mitral Valve Stenosis / Q000209:etiology / Q000503:physiopathology; D015999:Multivariate Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome