Valvular Heart DiseaseAcute and Midterm Outcome After MitraClip Therapy in Patients With Severe Mitral Regurgitation and Left Ventricular Dysfunction
Section snippets
Methods
This observational cohort study complies with the Declaration of Helsinki and was approved by the institutional ethics committee. It was conducted in a prospective manner from September 2009 to July 2012, and all patients gave written informed consent before entering the study. Patients with symptomatic MR were included after discussion in the heart team, if eligible for clip placement and unsuitable for cardiac surgery or refusing surgical treatment. Surgical risk was based on the European
Results
One hundred forty-seven consecutive patients were intended to be treated by pMVR from September 2009 to June 2012. In 11 of these patients (7.5%), a clip could not be placed (for further details, see Figure 1). In the remaining 136 patients, at least 1 clip was placed, but in 6 of these patients (4.4%), a sufficient MR reduction of ≥I grade could not be achieved. Therefore, the acute success rate in this patient population was 88.4%. The patient population with at least 1 clip placed was
Discussion
This single-center study demonstrates a significant reduction of MR severity with a primary success rate of 88.4% and an improvement of hemodynamic measurements immediately after pMVR using the MitraClip, regardless of the LVEF, and although 56% of the treated patients did not meet the established morphologic inclusion criteria of the EVEREST trials.11, 16, 18 The first patient treated with the MitraClip in our center was enrolled in September 2009. Since then, we gained a lot of experience and
Disclosures
Drs. Sonne, Mehilli, and Hausleiter received speaker honoraria from Abbott Vascular. Dr. Orban received speaker honoraria from Roche. There is no conflict of interest for the other authors.
References (29)
- et al.
Mitral regurgitation
Lancet
(2009) - et al.
Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era
Ann Thorac Surg
(2006) - et al.
2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2014) - et al.
Future directions in degenerative mitral valve repair
Semin Thorac Cardiovasc Surg
(2007) - et al.
Midterm results of edge-to-edge mitral valve repair without annuloplasty
J Thorac Cardiovasc Surg
(2003) - et al.
Correction of mitral regurgitation in nonresponders to cardiac resynchronization therapy by MitraClip improves symptoms and promotes reverse remodeling
J Am Coll Cardiol
(2011) - et al.
The acute hemodynamic effects of MitraClip therapy
J Am Coll Cardiol
(2011) - et al.
Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study
J Am Coll Cardiol
(2012) - et al.
The EVEREST II Trial: design and rationale for a randomized study of the evalve MitraClip system compared with mitral valve surgery for mitral regurgitation
Am Heart J
(2010) - et al.
Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multicenter clinical trial of percutaneous mitral valve repair
Am J Cardiol
(2007)
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography
J Am Soc Echocardiogr
Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe
J Am Coll Cardiol
Assessment of longitudinal myocardial mechanics in patients with degenerative mitral valve regurgitation predicts postoperative worsening of left ventricular systolic function
J Am Soc Echocardiogr
Evolving concepts and technologies in mitral valve repair
Circulation
Cited by (0)
Drs. Lesevic and Sonne contributed equally to this work.
See page 755 for disclosure information.