title: What is a "good" result after transcatheter mitral repair? Impact of 2+ residual mitral regurgitation.
abstract: OBJECTIVE
  The study objective was to assess the impact on follow-up outcomes of residual mitral regurgitation 2+ in comparison with ≤ 1+ after MitraClip (Abbott Vascular Inc, Santa Clara, Calif) repair.
  
  
  METHODS
  We compared the outcomes of mitral regurgitation 2+ and mitral regurgitation ≤ 1 + groups among a population of 223 consecutive patients with acute residual mitral regurgitation ≤ 2+ who underwent MitraClip implantation at San Raffaele Scientific Institute (Milan, Italy) between October 2008 and December 2014.
  
  
  RESULTS
  Residual mitral regurgitation 2+ was found in 64 patients (28.7%). Overall actuarial survival was 63.1% ± 4.4% at 48 months. Cumulative incidence functions of cardiac death in patients with mitral regurgitation 2+ was significantly higher (Gray test P < .001) compared with the mitral regurgitation ≤ 1+ group. The adjusted hazard ratio was 5.28 (95% confidence interval, 2.41-11.56, P < .001). Cumulative incidence function of mitral regurgitation ≥ 3+ recurrence in patients with residual mitral regurgitation ≤ 1+ and mitral regurgitation 2+ at 48 months was 13.3% ± 3.8% and 45.2% ± 6.8%, respectively (Gray test P < .001). Multivariate model showed that mitral regurgitation 2+ was the only factor associated with the development of mitral regurgitation ≥ 3+ at follow-up (adjusted hazard ratio, 6.71; 95% confidence interval, 3.48-12.90; P < .001). Mitral regurgitation cause was not associated with cardiac death and recurrence of mitral regurgitation ≥ 3+ at follow-up. No relationship between New York Heart Association class and follow-up time after MitraClip implant was found (odds ratio, 1.07; 95% confidence interval, 0.98-1.15; P = .11), and factors related to postoperative New York Heart Association also included residual mitral regurgitation 2+ (P = .07).
  
  
  CONCLUSIONS
  Residual 2+ mitral regurgitation after MitraClip implantation was associated with worse follow-up outcomes compared with ≤ 1+ mitral regurgitation, including survival, symptom relief, and mitral regurgitation recurrence. Better efficacy should be pursued by transcatheter mitral repair technologies.
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: buzzatti.nicola@hsr.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Buzzatti
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Denti
authors.affiliation: Cardiac Surgery Department, Santa Croce Hospital, Cuneo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Schiavi
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Di Giannuario
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: MitraClip; mitral regurgitation; repair; transcatheter