title: Hemodynamic Improvement at Three Months after MitraClipÂ® Treatment in End-Stage Heart Failure Patients with Functional Mitral Regurgitation.
abstract: Functional mitral regurgitation (FMR) is common in patients with advanced heart failure and impaired left ventricular function. The study aim was to examine functional and hemodynamic effects at three months after MitraClip® implantation in high-risk surgical patients with FMR.
  
  
  
  A group of 93 patients was rejected for surgical treatment by heart-team decisions due to an inacceptable risk for conventional mitral valve surgery. Between October 2011 and May 2015, 89 of these patients (96%) were treated successfully with MitraClip implantation. A subsequent complete follow up was performed over three months in 32 patients with FMR, including pro-brain natriuretic peptide (pro-BNP) measurements, six-minute walk test, echocardiography, and right heart catheterization.
  
  
  
  The patients (mean age 73 ± 7 years) presented with a mean left ventricular ejection fraction (LVEF) of 32 ± 13%, and mitral regurgitation (MR) grade ≥3 in 30 of 32 cases (93%). All patients suffered from severe FMR and were highly symptomatic (NYHA functional class III or IV). The mean logistic EuroSCORE was 33%. MitraClip implantation resulted in a significant clinical improvement and reverse cardiac remodelling with a decrease in LV end-diastolic and LV endsystolic diameters, while LVEF was unchanged. In addition, a statistically relevant reduction of systolic, diastolic and mean pulmonary artery pressures (PAPsystolic -7.2 mmHg, p = 0.011; PAPdiastolic -4.5 mmHg, p = 0.003; and PAPmean -5.3 mmHg, p = 0.007) were measured, while the cardiac index (+0.3 l/min/m2, p <0.001) and cardiac output (+0.5 l/min, p <0.001) were increased significantly. The 30-day mortality was 8.6% (n = 8).
  
  
  
  Among the study population, MitraClip implantation led to clinical improvement, reverse cardiac remodeling, and a sustained hemodynamic benefit during the three-month follow up period.
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany. Electronic correspondence: sebastian.barth@kardiologie-bad-neustadt.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Barth
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Martina B
authors.initials: MB
authors.lastname: Hautmann
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kerber
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Gietzen
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zacher
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Halbfass
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Müller
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schade
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Anno
authors.initials: A
authors.lastname: Diegeler
authors.affiliation: Department of Cardiology, University of Marburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schieffer
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Hamm
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D020257:Ventricular Remodeling