title: Long-term outcome of patients with severe biventricular heart failure and severe mitral regurgitation after percutaneous edge-to-edge mitral valve repair.
abstract: OBJECTIVE
  To assess long-term outcome and parameters associated with poor and favorable outcome in patients with a left ventricular ejection fraction (LV-EF) ≤25% and severe mitral regurgitation (MR) after percutaneous edge-to-edge mitral valve repair (pMVR).
  
  
  BACKGROUND
  There is no data on long-term outcome in this cohort of patients.
  
  
  METHODS
  We analyzed all 34 patients with a LV-EF ≤25% and severe MR treated with pMVR in 2 university hospitals from 2009 to 2012.
  
  
  RESULTS
  Mitral regurgitation could be successfully reduced to grade ≤2 in 30 patients (88%). Long-term follow-up (up to 5 years) revealed a steep decline of the survival curve reaching 50% already 8 month after pMVR. In contrast, estimated survival of the remaining patients showed a favorable long-term outcome. Patients deceased during the first year presented with higher right ventricular tricuspid pressure gradient (RVTG) (44.5 ± 8.4 mmHg vs. 35.2 ± 15.4 mmHg, P = 0.035) and worse RV-function (P = 0.014) prior to the procedure. One-year mortality of patients with pulmonary hypertension and depressed RV-function (n = 22) was very high (77%) compared to the remaining patients (n = 12, mortality rate of 0%, P = 0.0001).
  
  
  CONCLUSIONS
  Although pMVR lead to a successful reduction of MR in patients with a LV-EF ≤25%, 1-year mortality in this cohort was very high. However, a subgroup of patients showed a favorable long-term outcome after pMVR. Especially the right ventricular parameters sustained RV-function and absence of pulmonary hypertension-easily assessed with echocardiography-might be used to identify this subgroup and encourage pMVR in these patients.
authors: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors: Martin
authors: M
authors: Orban
authors: Daniel
authors: D
authors: Braun
authors: Mathias
authors: M
authors: Orban
authors: Christian
authors: C
authors: Grebmer
authors: Dirk
authors: D
authors: Sibbing
authors: Raffael
authors: R
authors: Thaler
authors: Janine
authors: J
authors: Tittus
authors: Fritz
authors: F
authors: Wimbauer
authors: Hasema
authors: H
authors: Lesevic
authors: Carolin
authors: C
authors: Sonne
authors: Julinda
authors: J
authors: Mehilli
authors: Ilka
authors: I
authors: Ott
authors: Michael
authors: M
authors: Näbauer
authors: Steffen
authors: S
authors: Massberg
authors: Peter
authors: P
authors: Boekstegers
authors: Jörg
authors: J
authors: Hausleiter
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000150:complications / Q000401:mortality / Q000601:surgery*