title: Acute and Midterm Outcome After MitraClip Therapy in Patients With Severe Mitral Regurgitation and Left Ventricular Dysfunction.
abstract: The clinical outcome of patients with severe primary and secondary mitral regurgitation (MR) and heart failure or significantly reduced left ventricular ejection fraction (LVEF) who underwent percutaneous mitral valve repair (pMVR) is yet not well known. This study compares midterm outcome of patients with severe left ventricular dysfunction (EF ≤30%) versus patients with slightly or moderately reduced or normal LVEF (EF >30%) after pMVR. One hundred thirty-six consecutive patients were enrolled: 42 patients displayed severe left ventricular dysfunction, group 1 (logistic EuroSCORE I 27.7 ± 21.8%; secondary MR in 37 patients), and 94 patients displayed slightly or moderately reduced or normal LVEF, group 2 (logistic EuroSCORE I 17 ± 18.2%; secondary MR in 21 patients). The primary efficacy endpoint was death of any cause, repeat mitral valve intervention, and/or New York Heart Association class ≥III, which was reached in 31% of patients in group 1 versus 40% in group 2 (p = 0.719) at a median follow-up of 371 days. MR, graded by transthoracic echocardiography, was reduced in both groups (p <0.001) and New York Heart Association class improved in each group (p <0.001), with no differences between groups (p >0.05). In conclusion, at midterm follow-up, the pMVR provided significant clinical benefits with comparable results achieved both in patients with significantly reduced and in patients with moderately reduced to normal LVEF. Thus, pMVR represents a feasible and effective treatment in high-risk patients who otherwise have limited therapeutic options and no safe option to reduce MR.
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. Electronic address: lesevic@dhm.mhn.de.
authors.forename: Hasema
authors.initials: H
authors.lastname: Lesevic
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Sonne
authors.affiliation: Medizinische Klinik und Poliklinik I, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Braun
authors.affiliation: Medizinische Klinik und Poliklinik I, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Orban
authors.affiliation: Department of Cardiology, Schön Klinik Starnberger See, Berg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pache
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.affiliation: Medizinische Klinik und Poliklinik I, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.affiliation: I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Barthel
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Ilka
authors.initials: I
authors.lastname: Ott
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Sack
authors.affiliation: Medizinische Klinik und Poliklinik I, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Massberg
authors.affiliation: Medizinische Klinik und Poliklinik I, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*