title: Percutaneous mitral repair with the MitraClip system in patients with mild-to-moderate and severe heart failure: a single-centre experience.
abstract: OBJECTIVE
  Edge-to-edge repair of mitral regurgitation (MR) with the MitraClip(®) (MC) system is increasingly applied in advanced heart failure. Our objective was to compare outcomes in patients with mild-to-moderate and severe systolic heart failure.
  
  
  RESULTS
  Between February 2010 and July 2012, 121 patients with MR of at least grade 3+ and a mean EuroSCORE II of 10.6% underwent MC implantation. Thirty-nine had a left ventricular ejection fraction (LVEF) of ≤30% (group A) and 82 of >30% (group B). Procedural success was comparable in both groups (100% vs. 95.2%) with multiple (>2) clip implantation in 34% and 25% of patients, respectively. At 12 months, absolute reduction in MR grade (2.3 vs. 2.2) and relative reduction in mitral valve orifice area (48% vs. 42%) were also comparable. New York Heart Association class had improved independent from baseline LVEF (P < 0.001). In-hospital mortality was low in both groups (2.6% vs. 2.4%), but there was a strong trend for higher 12-month mortality in group A (34% vs. 18%, P = 0.05) with no significant difference in the overall rate of major adverse cerebrovascular and cardiac events (36.8% vs. 28.9%, P = 0.38). On multivariate analysis, MR grade after repair was the strongest predictor of mortality (OR 2.121, 95% CI 1.095-4.109), whereas systolic impairment was no independent predictor.
  
  
  CONCLUSIONS
  Percutaneous mitral valve repair led to comparable symptomatic improvement in patients with mild-to-moderately or severely reduced LV function. LV-EF < 30% was not an independent predictor of short-term mortality, which was mainly governed by residual MR after repair.
authors.affiliation: Heart Center Rostock, University Hospital Rostock, Rostock, Germany.
authors.forename: Ilkay
authors.initials: I
authors.lastname: Bozdag-Turan
authors.forename: Liliya
authors.initials: L
authors.lastname: Paranskaya
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
authors.forename: R Gökmen
authors.initials: RG
authors.lastname: Turan
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
authors.forename: Yannik
authors.initials: Y
authors.lastname: Stoeckicht
authors.forename: Jochen
authors.initials: J
authors.lastname: Schubert
authors.forename: Bernd
authors.initials: B
authors.lastname: Westphal
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; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Clinical outcomes; Left ventricular remodeling; MitraClip; Severe heart failure