title: MitraClip implantation for high risk patients with severe mitral regurgitation: the Sheba experience.
abstract: BACKGROUND
  Percutaneous edge-to-edge mitral valve repair using the MitraClip system has evolved as a new tool in the treatment of mitral regurgitation (MR).
  
  
  OBJECTIVE
  To present our initial experience with MitraClip implantation in 20 high risk patients at Sheba Medical Center.
  
  
  METHODS
  Twenty high surgical risk patients with symptomatic significant MR underwent MitraClip implantation. Clinical and echocardiographic parameters were recorded at baseline and at follow-up.
  
  
  RESULTS
  The patients' mean age was 76 years and 65% were male. Coronary artery disease was present in 85% and 45% ent in had previous bypass surgery. Renal failure was present in 65%, atrial fibrillation in 60%, and 30% had an implantable cardioverter defibrillator/cardiac resynchronization therapy device. Mean left ventricular ejection fraction was 36%. Grade III-IV MR was present in all patients with the vast majority suffering from functional MR secondary to ventricular remodeling. New York Heart Association (NYHA) class was III-IV in 90%. Patients were followed for a mean of 231 days. Acute reduction of MR grade to < or = 2 was accomplished in 19 of the 20 patients (95%) with a 30 day mortality of 5%. At follow-up MR was reduced to < or = 2 in 64% of patients, and NYHA class improved in 70% of patients. An additional 2 patients (11%) died during follow-up.
  
  
  CONCLUSIONS
  MitraClip implantation is feasible and safe in high risk highly symptomatic patients with significant MR. Acute and mid-term results are comparable to similar high risk patient cohorts in the literature. Continued surveillance and longer follow-up are needed to elucidate which patients are most likely to benefit from the procedure.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.forename: Ilan
authors.initials: I
authors.lastname: Hay
authors.forename: Micha
authors.initials: M
authors.lastname: Feinberg
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis; D014463:Ultrasonography