title: Meta-analysis of the usefulness of Mitraclip in patients with functional mitral regurgitation.
abstract: Midterm outcomes for patients presenting with heart failure and functional mitral regurgitation (MR) treated with Mitraclip remain unclear. Pubmed, Medline, and Google Scholar were systematically searched for studies enrolling patients with severe-moderate MR who underwent Mitraclip implantation. All events after at least 6 months were the primary safety end point (including death, rehospitalization for heart failure, and reinterventions), whereas change in the ejection fraction, left ventricular volumes, arterial pulmonary pressure, and left atrial diameters were considered as secondary end points. Meta-regression analysis was performed to evaluate the effect of baseline clinical and echocardiographic parameters on efficacy outcomes: 875 patients were included in 9 studies; 1.48 clips (1.3 to 1.7) for patients were implanted, and after a median follow-up of 9 months (6 to 12), 409 patients (78% [75% to 83%]) were in class New York Heart Association I/II and 57 (11% [8% to 14%]) still had moderate-to-severe MR. Overall adverse events occurred in 137 (26% [20% to 31%]) of the patients and 78 (15% [1% to 17%]) of them died; 6-minute walk test improved by 100 m (83 to 111), whereas a significant reduction in left ventricular volumes and systolic pulmonary pressure was reported. At meta-regression analysis, an increase in left ventricle systolic volumes positively affected reduction of volumes after Mitraclip, whereas atrial fibrillation reduced the positive effect of the valve implantation on ejection fraction on end-diastolic and -systolic volumes. In conclusion, Mitraclip represents an efficacious strategy for patients with heart failure and severe MR. It offers a significant improvement in functional class and in cardiac remodeling, in patients with severely dilated hearts as well, although its efficacy remains limited in the presence of atrial fibrillation.
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'ascenzo
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Walter Grosso
authors.initials: WG
authors.lastname: Marra
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Montefusco
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omede
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy; Cardiology Department, Assuit university hospital, Assuit, Egypt. Electronic address: meshmeshaya11@yahoo.com.
authors.forename: Salma
authors.initials: S
authors.lastname: Taha
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.affiliation: Cardiology Department, University Heart Center, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.affiliation: Cardiology Department, Herz-&Gefässechirurgie, UniversitätsSpital Zürich, Zurich, Switzerland.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Frea
authors.affiliation: Department of Medical Science, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pidello
authors.affiliation: Cardiology Department, University of Cologne, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Rudolph
authors.affiliation: Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
authors.affiliation: Division of Cardiology, Cardiology Department, University of Munich, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Braun
authors.affiliation: Division of Cardiology, Univeristà degli Studi di Siena, Siena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.affiliation: Department of Cardiology, Vivantes Klinikum Friedrichshain, Berlin, Germany.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Ince
authors.affiliation: Rabin Medical Center, Petach-Tikva, Israel.
authors.forename: Leor
authors.initials: L
authors.lastname: Perl
authors.affiliation: Department of Medico-Surgical Sciences and Bio Technologies, Sapienza University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zoccai
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Amico
authors.affiliation: Cardiac Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D006350:Heart Valve Prosthesis; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D016276:Ventricular Function / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*