title: Percutaneous vs surgical repair of mitral valve regurgitation: single institution early and midterm outcomes.
abstract: BACKGROUND
  The objective of this study was to compare outcomes of surgical repair (SR) vs MitraClip (MC) implantation for severe mitral regurgitation (MR).
  
  
  METHODS
  A retrospective analysis of patients treated within a single institution was performed. Patients had EuroSCORE [European System for Cardiac Operative Risk Evaluation] < 20%, left ventricular ejection fraction ≥45%, and grade 3+/4+ MR.
  
  
  RESULTS
  Fifty patients (24 [48%] MC group, 26 [52%] SR group) with EuroSCORE 7.9 ± 5.6 were included. The MC group included 24 (48%) and the SR group 26 (52%) patients. Patients in the MC group had a significantly more complex comorbid profile (P < 0.001). Successful MC placement was in 22 patients (91.7%) and SR in 26 (100%). At discharge, no patient had grade 3+/4+ MR. There were no in hospital or 30-day deaths. At follow-up (mean 526 ± 398 days), further mitral valve surgery was necessary in 1 (3.8%) patient in the SR group and in 2 (8.3%) patients in the MC group (P = 0.26). One-year freedom from composite end point (death, stroke, myocardial infarction, major bleeding, cardiac rehospitalization) was 75.5% (SR 83% vs MC 67%; P = 0.18). Degree of residual MR Degree of residual MR immediately after the procedure was equally distributed in both groups (P = 0.13) and the sole independent determinant for composite outcome (odds ratio, 16.9; P = 0.024).
  
  
  CONCLUSIONS
  MC in nonsurgical candidates and SR in surgical patients showed similar perioperative and follow-up outcomes at an institution experienced with both techniques. Neither MC nor SR were independently related to outcome whenever similar degrees of acute correction with minimal residual MR were achieved. However, these findings should be interpreted within the selection biases and the numerical limitations of the present study.
authors.affiliation: Heart Center, University Hospital, 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: Henrik
authors.initials: H
authors.lastname: Schneider
authors.forename: Bernd
authors.initials: B
authors.lastname: Westphal
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
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; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome