Percutaneous edge-to-edge repair in high-risk and elderly patients with degenerative mitral regurgitation: midterm outcomes in a single-center experience.
OBJECTIVE
The study objective was to report the midterm outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with degenerative mitral regurgitation.


METHODS
From October 2008, data of all high-risk or elderly patients with severe degenerative mitral regurgitation who underwent MitraClip implantation were prospectively collected.


RESULTS
Forty-eight high-risk consecutive patients with severe degenerative mitral regurgitation underwent MitraClip implantation (mean age, 78.5 ± 10.8 years; 56.6% of the patients were aged ≥ 80 years). Mean Society of Thoracic Surgeons score was 12% ± 10%, and 71% were in New York Heart Association class III or IV. Mean left ventricular ejection fraction was 57% ± 11%. The device was successfully implanted in 47 of 48 patients (98%). In-hospital mortality was 2%. The median intensive care unit stay was 22 hours; patients were discharged from the hospital in an average of 4.5 ± 2.4 days. Predischarge echocardiography showed a mitral regurgitation reduction to grade 2+ or less in 43 of 47 patients (91.5%). Actuarial survival was 89% ± 5.2% and 70.2% ± 9% at 1 and 2 years, respectively (82% ± 9% in patients aged <80 years and 95% ± 4.4% in patients aged ≥ 80 years at 1 year; P = .9). Freedom from mitral regurgitation 3+ or greater was 80% ± 7% at 1 year and 76.6% ± 7% at 2 years. At 1 year, 93% of survivors were in New York Heart Association class I or II (100% of patients aged <80 years and 88% of patients aged ≥ 80 years; P = .4). Significant quality of life improvements were documented. A significant improvement in 6-minute walk test performance was observed.


CONCLUSIONS
MitraClip therapy is a valuable alternative to surgery in high-risk and elderly patients with degenerative mitral regurgitation. Clinical benefits also are obtained in octogenarians.
Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy. Electronic address: taramasso.maurizio@hsr.it.
Maurizio
M
Taramasso
Division of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
Francesco
F
Maisano
Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
Paolo
P
Denti
Interventional Cardiology Unit, San Raffaele University Hospital, Milan, Italy.
Azeem
A
Latib
Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
Giovanni
G
La Canna
Interventional Cardiology Unit, San Raffaele University Hospital, Milan, Italy.
Antonio
A
Colombo
Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
Ottavio
O
Alfieri
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D017079:Exercise Tolerance; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left