Original Title: Randomized Comparison of Percutaneous Repair and Surgery for Mitral Regurgitation. 5 – Years Results of EVEREST II. Reference: Ted Feldman et al. J Am Coll Cardiol 2015;66:2844-54

Courtesy of Dr. Carlos Fava

The MitraClip at 12 months in the EVEREST II trial showed similar outcomes to that of surgery, with improved ventricular remodeling and clinical outcomes but higher rates of residual mitral regurgitation. Long term evolution was yet to be assessed.

279 patients were randomized; 184 received the MitraClip and 95 were treated with surgery. The analyzed cohort included 154 patients (87%) treated with MitraClip and 56 (70%) with surgery. Baseline characteristics were well balanced.

At 5 years, the combined end point of death, surgery and 3+ or 4+ mitral regurgitation was 44.2% vs. 64.3% (p=0.01) in favor of surgery. This was due to increased rates of 3+ or 4+ mitral regurgitation (12.3% vs. 1.8%; p=0.02) and the need for surgery (27.9% vs. 8.9%; p=0.003). The need for surgery after MitraClip was, in most cases (78%) within the first 6 months. After this period, no differences were observed between the groups.
There were no differences in mortality or functional class at 5 years (20.8% vs. 26.8%).

In multivariable analysis, the strategy of percutaneous intervention with MitraClip vs. surgery was not associated with mortality.

Conclusion
Patients receiving percutaneous repair required more surgery due to residual mitral regurgitation during the first year, but after the first year and up to 5 years of follow up, there was a low rate of events, similar to that of surgical repair.

Editorial Comment
This randomized study shows the safety and efficacy of MitraClip at long term, with no echocardiographic alterations at 5 years, with improved ventricular remodeling, similar to that of surgery.
The drawback is a higher rate of mitral regurgitation during the first 6 months, associated to the need for surgery. Once past this period, it has the same benefits of surgery and is less aggressive for patients.

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation– Buenos Aires