title: Predictors for long-term survival after transcatheter edge-to-edge mitral valve repair.
abstract: OBJECTIVE
  To determine predictors for long-term outcome in high-risk patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) for severe mitral regurgitation (MR).
  
  
  BACKGROUND
  There is no data on predictors of long-term outcome in high-risk real-world patients.
  
  
  METHODS
  From August 2009 to April 2011, 126 high-risk patients deemed inoperable were treated with TMVR in two high-volume university centers.
  
  
  RESULTS
  MR could be successfully reduced to grade ≤2 in 92.1% of patients (116/126 patients). Long-term clinical follow-up up to 5 years (95.2% follow-up rate) revealed a mortality rate of 35.7% (45/126 patients). Repeat mitral valve treatment (surgery or intervention) was needed in 19 patients (15.1%). Long-term clinical improvement was demonstrated with 69% of patients being in NYHA class ≤II. In a multivariable Cox regression analysis, the post-procedural grade of MR (hazard ratio [HR] 1.55 per grade, P = 0.035), the left ventricular ejection fraction (HR 0.58 for difference between 75th and 25th percentile, P = 0.031) and the glomerular filtration rate (HR 0.33 for 75th vs 25th percentile, P < 0.001) were independent predictors for long-term mortality. Patients with primary MR and a post-procedural MR grade ≤1 had the most favorable long-term outcome.
  
  
  CONCLUSIONS
  This study determines predictors of long-term clinical outcome after TMVR and demonstrates that the grade of residual MR determines long-term survival. Our data suggest that it might be of benefit reducing residual MR to the lowest possible MR grade using TMVR-especially in selected high-risk patients with primary MR who are not considered as candidates for surgical MVR.
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Mathias
authors.identifier: http://orcid.org/0000-0001-7846-8808
authors.initials: M
authors.lastname: Orban
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0001-9830-1941
authors.initials: M
authors.lastname: Orban
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Hasema
authors.initials: H
authors.lastname: Lesevic
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Braun
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Deseive
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Sonne
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hutterer
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Grebmer
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Khandoga
authors.affiliation: Kardiologie, Schön-Klinik Starnberger See, Starnberg-Berg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pache
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.affiliation: Herzchirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Massberg
authors.affiliation: Medizinische Klinik, Kardiologie, Angiologie, HELIOS Klinikum Siegburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Nabauer
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Ilka
authors.initials: I
authors.lastname: Ott
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D000069451:Long Term Adverse Effects / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D020379:Risk Adjustment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: MitraClip; functional mitral regurgitation; heart failure; mitral valve regurgitation; percutaneous edge-to-edge mitral valve repair; transcatheter edge-to-edge mitral valve repair