title: Association of tricuspid regurgitation with clinical and echocardiographic outcomes after percutaneous mitral valve repair with the MitraClip System: 30-day and 12-month follow-up from the GRASP Registry.
abstract: OBJECTIVE
  The aim of this study was to evaluate the association of baseline tricuspid regurgitation (TR) on the outcomes after percutaneous mitral valve repair (PMVR) with the MitraClip system.
  
  
  RESULTS
  Data from 146 consecutive patients with functional mitral regurgitation (MR) were obtained. Two different groups, dichotomized according to the degree of pre-procedural TR (moderate/severe, n = 47 and none/mild, n = 99), had their clinical and echocardiographic outcomes through 12-month compared. At 30-day, the primary safety endpoint was significantly higher in moderate/severe TR compared with none/mild TR (10.6 vs. 2.0%, P = 0.035). Marked reduction in MR grades observed post-procedure were maintained through 12 months. Although NYHA functional class significantly improved in both groups compared with baseline, it was impaired in moderate/severe TR compared with the none/mild TR group (NYHA > II at 30 day: 33.3 vs. 9.2%, P < 0.001; at 1 year: 38.5 vs. 12.3%, respectively, P = 0.006). Left ventricle reverse remodelling and ejection fraction improvement were revealed in both groups. The primary efficacy endpoint at 12-month determined by freedom from death, surgery for mitral valve dysfunction, or grade ≥ 3+ MR was comparable between groups, but combined death and re-hospitalization for heart failure rates were higher in the moderate/severe TR group. Multivariable Cox regression analysis demonstrated that baseline moderate/severe TR and chronic kidney disease were independent predictors of this combined endpoint.
  
  
  CONCLUSIONS
  Although PMVR with MitraClip led to improvement in MR, TR, and NYHA functional class in patients with baseline moderate/severe TR, the primary safety endpoint at 30-day was impaired, while moderate/severe TR independently predicted death and re-hospitalization for heart failure at 12-month.
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy Department of Cardiology, University of Tokai School of Medicine, Isehara, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio, USA Department of Interventional Cardiology, Pitangueiras Hospital, Jundiai, Brazil.
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cannata
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Dipasqua
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immé
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Ministeri
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Caggegi
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Pistritto
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Chiarandà
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronsivalle
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Giaquinta
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Farruggio
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mangiafico
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Scandura
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy melfat75@gmail.com.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Grasso
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography; D023381:Endpoint Determination; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*
keywords: MitraClip; Mitral regurgitation; Percutaneous mitral valve repair; Tricuspid regurgitation