title: Effectiveness of MitraClip therapy in patients with refractory heart failure.
abstract: OBJECTIVE
  To assess outcomes for MitraClip therapy in patients with refractory heart failure (HF) and mitral regurgitation (MR) ≥3+.
  
  
  BACKGROUND
  The beneficial role of Mitraclip also in patients with severe HF has been reported.
  
  
  METHODS
  Out of 45 patients undergoing MitraClip implantation at our institute, 16 were on refractory HF defined as diuretics and/or inotropics infusion and/or IABP dependence (group A) or labile haemodynamic balance (group B).
  
  
  RESULTS
  Patients were aged 69 ± 13 years and 75% were males. Group A (8 patients) had a mean hospitalization length before MitraClip procedure of 5333 days. Group B (8 patients) had a mean rate of hospitalization, in the last 50 days before procedure, of 254 days. Acute procedural success was observed in 94% of patients. All but one patients of group A were quickly weaned from pharmacologic and/or mechanical supports within 5 ± 3 days from procedure and discharged at 20±10 days. All patients of group B were discharged after 10±8 days from MitraClip. At 1 year: a) cumulative survival rate was 78%; b) all patients were in NYHA functional class ≤ II; c) residual MR ≤ 2 was observed in 90%; d) systolic pulmonary arterial pressure was significantly reduced compared to the baseline (from 5410 to 398; p = 0,008); e) significant reduction of cumulative HF hospitalization days in the post-procedure year (10 days) compared to the pre-implantation year (280 days; p = 0.023) was observed.
  
  
  CONCLUSIONS
  In patients with refractory HF and MR ≥3+, MitraClip implantation resulted in acute and persistent clinical benefit and net reduction of HF re-hospitalization.
authors.affiliation: Spedali Civili, Brescia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Adamo
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Curello
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Ermanna
authors.initials: E
authors.lastname: Chiari
authors.forename: Giuliano
authors.initials: G
authors.lastname: Chizzola
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011474:Prosthesis Design; D011651:Pulmonary Artery