Original title: Percutaneous Mitral Valve Repair for Mitral Regurgitation in High-Risk Patients. Results of the EVEREST II Study. Reference: Donald D. Glower et al. J Am Coll Cardiol 2014;64:172-81

Severe mitral regurgitation (MR) often lead to hospitalization for cardiac failure and heart surgery. Half of these patients are rejected for high surgical risk. Percutaneous intervention is a valid alternative; however its long term evolution remains unclear.

351 patients were included (78 from the EVEREST II HRR and 273 from REALISM HR). The chosen device was Mitra-Clip and procedure was considered effective when MR was reduced to ≤2%. Median age was 75.7 with 70% of patients having functional MR and 11.3 STS.

In 57.3% of patients only one Mitra-Clip was used, 38.5% received 2 and in the remaining 12 implantation was not possible. There were no cases of death or surgery during procedure. Hospital stay was 3.2 days.  

At 30 days, mortality rate was 4.8% (no deaths were associated to Mitra-Clip malfunction), strokes rate was 2.6%, infarction rate was 1.1% and renal failure rate was 1.1%. The need for transfusion was 13.4%. At one year follow up, mortality rate reached 22.8%, infarction 2.3% and stroke 3.4%; not one patient required surgery. 

At follow up, left ventricular (LV) diameter saw a reduction, there were less admissions for cardiac failure and quality of life improved significantly. 

Conclusion

Percutaneous intervention with Mitra-Clip reduces MR, improves symptoms and reduces ventricular diameters at 12 months in the high risk cohort.

Commentary

The study shows that it is possible to treat the mitral valve in high risk symptomatic patients with favorable evolution at one year, according to scores such as STS, reducing hospital stay, ventricular diameters and admission rates, and improving functional class and quality of life. 

Courtesy Dr. Carlos Fava
Interventional cardiologist
Fundación Favaloro
Buenos Aires – Argentina

Carlos Fava