title: Percutaneous mitral valve repair: The last chance for symptoms improvement in advanced refractory chronic heart failure?
abstract: BACKGROUND
  The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear.
  
  
  METHODS
  Seventy-five consecutive patients with FMR grade≥3+ and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month.
  
  
  RESULTS
  Mean age was 67±11years, logistic EuroSCORE=23±18%, left ventricle ejection fraction (LVEF) 30±9%. In 6 patients (8%) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3% (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84%) were discharged with MR≤2+. At 6-month, 4 patients died (5%), 80% had MR≤2+ and 75% were in New York Heart Association class ≤II. Median pro-BNP decreased from 4395pg/ml to 2594pg/ml (p=0.04). There were no significant changes in LV end-diastolic volume (222±75ml vs. 217±79, p=0.19), end-systolic volume (LVESV, 154±66ml vs. 156±69, p=0.54) and LVEF (30±9% vs. 30±12%, p=0.86). Significant reverse remodeling (reduction of LVESV≥10%) was observed in 25%, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6months before PMVR were reduced from 1.1±0.8 to 0.3±0.6 (p<0.001).
  
  
  CONCLUSIONS
  In extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6months, despite the lack of LV reverse remodeling.
authors.affiliation: Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Berardini
authors.affiliation: Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.affiliation: Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Stolfo
authors.affiliation: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Previtali
authors.affiliation: Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Crimi
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Salvi
authors.affiliation: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrario
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: De Luca
authors.affiliation: Department of Cardiac Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gazzoli
authors.affiliation: Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy.
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.affiliation: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy. Electronic address: claudio.rapezzi@unibo.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling
keywords: Heart failure; Mitral regurgitation; Percutaneous mitral valve repair; Remodeling