Open AccessArticle
Percutaneous Mitral Valve Repair with the MitraClip™ System
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Oliver Gaemperli, Adrian Attinger-Toller, Antonio H. Frangieh, Ji-Na Yoon, Christiane Gruner, Jan Vontobel, Dominique Bettex, Frank Ruschitzka, Maurizio Taramasso, Roberto Corti, Thomas F. Lüscher and Francesco Maisano
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Abstract
OBJECTIVES: We performed extended follow-up for longer than 1 year in consecutive patients undergoing percutaneous mitral valve repair (PMVR) with the MitraClip™ system. BACKGROUND: PMVR with the MitraClip™ system has become a valid alternative to surgery for patients with severe mitral regurgitation, anatomical
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OBJECTIVES: We performed extended follow-up for longer than 1 year in consecutive patients undergoing percutaneous mitral valve repair (PMVR) with the MitraClip™ system. BACKGROUND: PMVR with the MitraClip™ system has become a valid alternative to surgery for patients with severe mitral regurgitation, anatomical suitability and high surgical risk, but data on long-term outcomes more than 1 year after the procedure are scarce. METHODS: We included 148 consecutive patients with symptomatic moderate– severe (3+) or severe (4+) mitral regurgitation, who underwent PMVR at the University Heart Centre Zurich between March 2009 and February 2014. Clinical endpoints on follow-up included all-cause death, mitral valve surgery/ reoperation, hospitalisation for congestive heart failure, and heart transplantation. RESULTS: Mitral regurgitation aetiology was functional in 57%, degenerative in 37%, and mixed in 6%. EuroSCORE I was 26 ± 14 and STS risk score for mortality was 8 ± 11%. Median follow-up was 1.9 years (interquartile range 0.8–2.7). Acute procedural success (defined as successful clip implantation with residual mitral regurgitation grade ≤2+) was achieved in 94% of patients. At 6 months’ follow-up, 67% of patients had a persistent good result with mitral regurgitation grade 1–2+. Event rates of the combined endpoint were 31% at 1 year and 53% at 2 years, and mortality was 18% at 1 year and 32% at 2 years. Baseline NYHA class and mitral regurgitation severity at discharge were independent predictors of the combined endpoint. CONCLUSIONS: PMVR with the MitraClip™ system allows durable reduction of mitral regurgitation severity and improvement in patients’ symptoms and functional status. Event rates, however, remain remarkably high despite successful treatment, reflecting the advanced age and high comorbidity status of our population.
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