title: Echocardiographic and clinical outcomes of central versus noncentral percutaneous edge-to-edge repair of degenerative mitral regurgitation.
abstract: OBJECTIVE
  This study aimed to assess the clinical and echocardiographic results of MitraClip implantation in noncentral degenerative mitral regurgitation (dMR) compared with central dMR.
  
  
  BACKGROUND
  It is unknown whether the use of MitraClip therapy in noncentral dMR is as safe and effective as in central dMR.
  
  
  METHODS
  We analyzed a multicenter registry of 173 patients treated with the MitraClip and compared results of central and noncentral dMR.
  
  
  RESULTS
  Seventy-nine patients (age 79.2 ± 8.0 years, 58.2% men) had dMR. Forty-nine patients (62%) had central dMR, with the remainder classified as noncentral dMR (n = 30, 38%). Patients with noncentral dMR had a wider pre-procedural vena contracta (8.5 ± 2.0 mm vs. 6.9 ± 2.2 mm, p = 0.039) and higher systolic pulmonary pressure (57.9 ± 18.0 vs. 47.3 ± 13.0 mm Hg, p = 0.019). Procedural success was the same in both groups (95.5% central vs. 96.7% noncentral, p = 0.866). Post-procedural MR and New York Heart Association (NYHA) functional class at 1 month (MR ≤2, 96.0% vs. 96.6%, p = 0.866, and NYHA functional class ≤II, 81.6% vs. 90.0%, p = 0.335) and 6 months (95.2% central vs. 91.7% noncentral, p = 0.679; and NYHA functional class >II, 21.1% vs. 0%, p = 0.128) did not differ between groups. There were also no differences in serious post-procedural adverse events: partial clip detachment (central n = 1 [2.0%] vs. noncentral n = 1 [3.3%], p = 1.000), death (5.4% central vs. 13.0% noncentral, p = 0.298), or heart failure admission (10.8% central vs. 8.7% noncentral, p = 0.791).
  
  
  CONCLUSIONS
  In experienced centers, MitraClip treatment can be performed safely and effectively in both central and noncentral dMR.
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark. Electronic address: owfranzen@gmx.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
authors.affiliation: Unit for Interventional Cardiology, Department of Cardiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Reidar
authors.initials: R
authors.lastname: Winter
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Sondergaard
authors.affiliation: Unit for Interventional Cardiology, Department of Cardiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Jacobsen
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Gary
authors.initials: G
authors.lastname: Cheung
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Ihlemann
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ghione
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Susanna
authors.initials: S
authors.lastname: Price
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Duncan
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Tine
authors.initials: T
authors.lastname: Streit Rosenberg
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Barker
authors.affiliation: National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: Unit for Interventional Cardiology, Department of Cardiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Settergren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: 2-dimensional; 2D; 3-dimensional; 3D; LV; MR; MV; NYHA; New York Heart Association; TEE; catheter-based-therapy; dMR; degenerative mitral regurgitation; heart valves; left ventricular; mitral regurgitation; mitral valve; transesophageal echocardiography