Original title: 4-Year Results of a Randomized Controlled Trial of Percutaneous Repair Versus surgery for Mitral Regurgitation. Reference: Laura Mauri, et al. J Am Coll Cardiol 2013;62:317-28
Surgical treatment of mitral regurgitation (MR) is currently recommended by either valve replacement or valvuloplasty. Devices are being developed to address this disease giving the benefits of percutaneous treatments. The EVEREST II, a prospective multicenter, randomized 2:1 study, unblind, compared Mitra Clip (MC), (Abbott, Menlo Park, California), versus mitral surgery. Patients included were symptomatic undergoing chronic mitral regurgitation 3 + or 4 +, ejection fraction >25% and end-diastolic diameter of the left ventricle (LVDD) ≤ 55 mm or asymptomatic with ejection fraction between 25% and 60%, LVDD 40 to 55 mm plus a new atrial fibrillation or pulmonary hypertension. 184 were included in the MC group and 95 in the surgical group (SG), characteristics of both groups were well balanced with the exception of a higher incidence of heart failure in the MC group. Half received a single clip and 38% two.
Four year follow-up was performed in 88% of the MC group and in 77% of the surgical group. No patient showed a device embolization. There was no difference in the valve area measured by planimetry or pressure-half time or the mean gradient. One single patient evolved mitral stenosis (area <1.5 cm2) in the MC group. At four years free of death, mitral valve surgery by dysfunction, IM 3 + or 4 + resulted in 39.8% of the MC group and 53.4%