title: Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip.
abstract: OBJECTIVE
  MitraClip implantation is evolving as a potential alternative treatment to conventional surgery in high-risk patients with significant mitral regurgitation (MR). However, outcome predictors are under-investigated. The aim of this study was to identify predictors of midterm mortality and heart failure rehospitalisation after percutaneous mitral valve repair with MitraClip.
  
  
  RESULTS
  A total of 150 consecutive patients were followed for a median of 463 days. Survival analyses were performed for baseline characteristics, risk scores and failure of acute procedural success (APS) defined as persisting MR grade 3+ or 4+. Univariate significant risk stratifiers were tested in multivariate analyses using a Cox proportional hazards model. Overall survival was 96% at 30 days, 79.5% at 12 months, and 62% at two years. Multivariate analysis identified APS failure (HR 2.13, p=0.02), NYHA Class IV at baseline (HR 2.11, p=0.01) and STS score ≥12 (HR 2.20, p<0.0001) as significant independent predictors of all-cause mortality, and APS failure (HR 2.31, p=0.01) and NYHA Class IV at baseline (HR 1.89, p=0.03) as significant independent predictors of heart failure rehospitalisation. Furthermore, a post-procedural significant decrease in hospitalisation rate could only be observed after successful interventions (0.89±1.07 per year before vs. 0.54±0.96 after implantation, p=0.01). Patients with severely dilated and overloaded ventricles who did not meet EVEREST II eligibility criteria were at higher risk of APS failure.
  
  
  CONCLUSIONS
  The failure of acute procedural success proved to have the most important impact on outcome after MitraClip implantation.
authors: Department of Cardiology, University Medical Centre Göttingen, Göttingen, Germany.
authors: Miriam
authors: M
authors: Puls
authors: Tobias
authors: T
authors: Tichelbäcker
authors: Annalen
authors: A
authors: Bleckmann
authors: Mark
authors: M
authors: Hünlich
authors: Katrin
authors: K
authors: von der Ehe
authors: Bo Eric
authors: BE
authors: Beuthner
authors: Karin
authors: K
authors: Rüter
authors: Tim
authors: T
authors: Beißbarth
authors: Ralf
authors: R
authors: Seipelt
authors: Friedrich
authors: F
authors: Schöndube
authors: Gerd
authors: G
authors: Hasenfuß
authors: Wolfgang
authors: W
authors: Schillinger
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 / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015999:Multivariate Analysis; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure