title: Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States.
abstract: BACKGROUND
  Transcatheter mitral valve (MV) repair with the MitraClip received approval in 2013 for the treatment of prohibitive-risk patients with primary mitral regurgitation (MR).
  
  
  OBJECTIVE
  The aim of this study was to report the initial U.S. commercial experience with transcatheter MV repair.
  
  
  METHODS
  Data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry on patients commercially treated with this percutaneous mitral valve repair device were analyzed.
  
  
  RESULTS
  Of 564 patients (56% men, median age 83 years), severe symptoms were present in 473 (86.0%). The median Society of Thoracic Surgeons Predicted Risk of Mortality scores for MV repair and replacement were 7.9% (interquartile range: 4.7% to 12.2%) and 10.0% (interquartile range: 6.3% to 14.5%), respectively. Frailty was noted in 323 patients (57.3%). Transcatheter MV repair was performed for degenerative disease, present in 90.8% of patients. Overall, MR was reduced to grade ≤2 in 93.0%. In-hospital mortality was 2.3%; 30-day mortality was 5.8%. Other 30-day events were stroke (1.8%), bleeding (2.6%), and device-related complications (1.4%). The median length of stay was 3 days (interquartile range: 1 to 6 days), with 84.0% patients discharged home. Overall, procedure success occurred in 90.6%. Variables associated with reduction in MR were end-diastolic dimension, MR severity, clip location, and case volume.
  
  
  CONCLUSIONS
  In this study of the initial commercial U.S. experience, it was found that procedural success was achieved in approximately 91% of patients, and the majority of patients were discharged home with moderate or less MR. These data support the effectiveness of this therapy in appropriately selected high-risk patients in a commercial setting. Further study is required to determine the long-term impact of transcatheter MV repair in this patient population.
authors.affiliation: Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address: paul.sorajja@allina.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Sorajja
authors.affiliation: Baylor Heart Hospital, Plano, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Vemulapalli
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: Amanda
authors.initials: A
authors.lastname: Stebbins
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: University of Virginia, Charlottesville, Virginia.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Patrick
authors.initials: P
authors.lastname: McCarthy
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: Baylor University Medical Center, Dallas, Texas.
authors.forename: Paul
authors.initials: P
authors.lastname: Grayburn
authors.affiliation: Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Wesley A
authors.initials: WA
authors.lastname: Pedersen
authors.affiliation: University of Virginia, Charlottesville, Virginia.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: mitral regurgitation; mitral repair; transcatheter