title: Residual mitral valve regurgitation after percutaneous mitral valve repair with the MitraClip® system is a risk factor for adverse one-year outcome.
abstract: OBJECTIVE
  We undertook this study to investigate the mid-term clinical results after MitraClip® implantation and the impact of post-repair mitral valve (MV) function and anatomy on survival and outcome composite endpoint in high-risk patients.
  
  
  BACKGROUND
  Percutaneous MV repair is a potential treatment option for high-risk patients with severe mitral regurgitation (MR).
  
  
  METHODS
  MitraClip® was implanted in patients with symptomatic MR rejected to conventional surgery. Differences between patients that survived at follow-up and patients deceased were tested. A stepwise Cox multivariate analysis was performed to identify independent predictors for composite endpoint of mortality, cardiac re-hospitalization, re-intervention, and major cerebro-vascular and cardiac events.
  
  
  RESULTS
  A total of 85 consecutive patients [78 ± 6 years, 48 (56.5%) men] with severe MR were included. There was no operative mortality while in-hospital mortality was 3.5% (n = 3) and 30-day mortality 4.7% (n = 4). Follow-up was 211 ± 173 days. Survival and composite endpoint-free survival at one year were 71% and 55%. Multivariate analysis revealed that residual MR immediately after MitraClip® placement (OR 7.4; 95% CI 2.3-23.7) and preoperative MV gradient (OR 2.7; 95% CI 1.5-5.0) were predictors for composite endpoint. Chronic obstructive pulmonary disease (OR 8.3; 95% CI 1.9-37.1) was an additional predictor for composite endpoint.
  
  
  CONCLUSIONS
  MitraClip® is a valid tool with favorable outcomes in high-risk patients. The degree of residual MR seems to impact on follow-up composite endpoint outcome. An optimal correction of MR after MitraClip placement could be advocated to optimize the benefits of the procedure and minimize the risk of adverse outcomes.
authors.affiliation: Heart Center Rostock, University Hospital Rostock, Rostock School of Medicine, 18057 Rostock, Germany.
authors.forename: Liliya
authors.initials: L
authors.lastname: Paranskaya
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ancona
authors.forename: Ilkay
authors.initials: I
authors.lastname: Bozdag-Turan
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.forename: Gökmen R
authors.initials: GR
authors.lastname: Turan
authors.forename: Tim
authors.initials: T
authors.lastname: Rehders
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
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; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome