Original title: Residual Mitral Valve Regurgitation After Percutaneous Mitral Valve Repair with Mitraclip® System in a Risk Factor of Adverse one-Year Outcome Reference: Liliya Paranskaya et al. Catheterization and Cardiovascular Intervention 81:609-617 (2013).

Currently, the gold standard for the treatment of mitral regurgitation (MR) is surgery but 20% of patients are rejected because they present a high surgical risk. 

The aim of this study was to analyze the mid-term results of patients treated with MR MitraClip® (Abbott Vascular, Melon Park, CA). Between February 2010 and December 2011, 85 patients with severe MR and high surgical risk were included. Procedure success was defined as implanting a clip with at least one residual MR degree ≤ 2 and no significant new mitral stenosis. 

All patients were symptomatic for their valve disease and a high surgical risk mean EuroSCORE of 24 ± 12. Procedural success was achieved in 82 patients (96.4%); of these patients 47 received two clips and 24, more than two clips. With the MitraClip® a significant reduction in the area of the mitral orifice, 5.1 ± 1 cm ² to 2.9 ± 0.5 cm ² (p = 0.001), was achieved and also an increase in trans-mitral gradient of 2.3 ± 1 mm Hg to 3.4 ± 1.4 mmHg (p = 0.001). 30-day mortality was 4.7% and 29% at follow-up 211 ± 173 days. 

We observed an improvement in functional class in 69 patients, (81.2%), and none in class IV. 20% required new hospitalization for heart failure. The event-free survival rate was 66%. In multivariate analysis residual MR post procedure, the previous gradient and chronic obstructive pulmonary disease were predictors of poor outcome.

Conclusion 

The MitraClip® is a safe and feasible option in patients with severe mitral regurgitation and high risk. The degree of residual mitral regurgitation adversely impacting was on track.

Comment

Percutaneous mitral valve treatment provides an opportunity for many patients whose condition means they are not candidates for surgery. This is a very challenging procedure, since fluoroscopy is of little use, and we depend almost exclusively on trans-esophageal echo images for the correct implant. 

Courtesy of Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Argentina.

Dr. Carlos Fava para SOLACI.ORG