title: Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy.
abstract: OBJECTIVE
  As periprocedural risk is low, MitraClip implantation is often performed in critically ill, not fully recompensated patients, who are in NYHA functional class IV at the time of the procedure, to accelerate convalescence. We herein sought to evaluate the procedural and 30-day outcome of this patient group.
  
  
  RESULTS
  A total of 803 patients undergoing MitraClip implantation were included in the German Mitral Valve Registry, and 30-day outcomes were prospectively assessed. Patients were separated based on NYHA functional class [(NYHA IV (n = 143), III (n = 572), and I/II (n = 88)]. No difference was noted in co-morbities and echocardiographic parameters of LV function between groups. However, parameters of severity of mitral regurgitation (MR) were higher in NYHA IV patients. High procedural success rates and low residual MR grades at discharge were observed throughout all groups. In-hospital major adverse cardiac events were similar between groups. Importantly, 30-day mortality (8.0% vs. 3.2% vs. 4.8%; P < 0.05) was significantly higher in NYHA IV patients, whereas rehospitalization did not differ between groups. At 30 days, 47.6% of NYHA IV patients were still in NYHA class III or IV compared with 32.5% and 14.8% in the other groups (P < 0.05), although NYHA functional class decreased in 69% of patients. Quality of life, which was very poor at baseline, showed an overall improvement in NYHA IV patients after 30 days, with, for example, a reduction of bed-ridden patients from 19.6% to 3.3%.
  
  
  CONCLUSIONS
  MitraClip therapy is feasible and safe even in critically ill, not fully recompensated patients and leads to symptomatic improvement in over two-thirds of these patients; however, it is associated with an elevated 30-day mortality.
authors.affiliation: Heart Center, University of Cologne, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Rudolph
authors.forename: Michael
authors.initials: M
authors.lastname: Huntgeburth
authors.forename: Ralph Stephan
authors.initials: RS
authors.lastname: von Bardeleben
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.forename: Edith
authors.initials: E
authors.lastname: Lubos
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.forename: Taoufik
authors.initials: T
authors.lastname: Ouarrak
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Christian
authors.initials: C
authors.lastname: Butter
authors.forename: Björn
authors.initials: B
authors.lastname: Plicht
authors.forename: Andreas
authors.initials: A
authors.lastname: May
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
mesh_terms: D000368:Aged; D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Heart failure; MitraClip; Outcome