title: MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: mid-term results of a single-centre experience†.
abstract: OBJECTIVE
  To compare the surgical and percutaneous edge-to-edge (EE) repair in patients with severe left ventricular (LV) dysfunction and secondary mitral regurgitation (MR).
  
  
  METHODS
  We reviewed the prospectively collected data of the first 120 consecutive patients (age: 65 ± 9.8 years, EF: 28 ± 8.2%) treated with surgical (65 patients) or percutaneous (55 patients) EE repair for severe secondary MR in our institution. Age (P = 0.005) and logistic European System for Cardiac Operative Risk Evaluation (P < 0.0001) were significantly higher in the MitraClip group. LVEF (P = 0.37), end-diastolic (P = 0.83) and end-systolic (P = 0.68) volumes and systolic pulmonary artery pressure (SPAP) (P = 0.58) were similar. The follow-up was 100% complete [median: 4 years; interquartile range (IQR): 2.2-7.2].
  
  
  RESULTS
  The length of hospital stay was 10 days (IQR: 8-13) for surgery and 5 days (IQR: 3.9-7.8) for MitraClip (P < 0.0001). Hospital mortality (3 vs 0%, P = 0.49) and freedom from cardiac death at 4 years (80.8 ± 4.9% vs 79.1 ± 5.9%, P = 0.9) were not significantly different in the surgical and MitraClip group, respectively. Residual MR ≥ 2+ at hospital discharge was 7.6% for surgery and 29% for MitraClip (P = 0.002). At 4 years, freedom from MR ≥ 2+ (74.9 ± 5.6% vs 51.4 ± 7.4%, P = 0.01) and freedom from MR ≥ 3+ (92.8 ± 3.4% vs 68.1 ± 7%, P = 0.002) were both significantly higher in the surgical group. Multivariate analysis identified the use of MitraClip as an independent predictor of recurrence of MR ≥ 2+ [Hazard ratio (HR): 2.1, 95% confidence interval (CI): 1.1-3.9, P = 0.02] as well as of MR ≥ 3 (HR: 6.1, 95% CI: 1.5-24.3, P = 0.01). In the surgical group, no predictors of cardiac mortality were identified. In the MitraClip group, left ventricular end-diastolic diameter (HR: 1.1, 95% CI: 1-1.2, P = 0.005) and SPAP (HR: 1, 95% CI: 1-1.1, P = 0.005) were independent predictors of cardiac death at the follow-up.
  
  
  CONCLUSIONS
  MitraClip therapy is a safe therapeutic option in selected high-risk patients with secondary MR and relevant comorbidities. The surgical EE provides higher efficacy both postoperatively and at the mid-term follow-up.
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy michele.debonis@hsr.it.
authors: Michele
authors: M
authors: De Bonis
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Maurizio
authors: M
authors: Taramasso
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Elisabetta
authors: E
authors: Lapenna
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Paolo
authors: P
authors: Denti
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Giovanni
authors: G
authors: La Canna
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Nicola
authors: N
authors: Buzzatti
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Federico
authors: F
authors: Pappalardo
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Giovanna
authors: G
authors: Di Giannuario
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Micaela
authors: M
authors: Cioni
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Andrea
authors: A
authors: Giacomini
authors: Department of Cardiac Surgery, IRCCS San Raffaele Institute, Milan, Italy.
authors: Ottavio
authors: O
authors: Alfieri
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D019736:Prostheses and Implants; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: MitraClip; Mitral valve repair; Percutaneous mitral repair; Secondary mitral regurgitation