Residual mitral valve regurgitation after percutaneous mitral valve repair with the mitraclip® system is a risk factor for adverse one-year outcome

Objectives We undertook this study to investigate the mid-term clinical results after MitraClip (R) implantation and the impact of post-repair mitral valve (MV) function and anatomy on survival and outcome composite endpoint in high-risk patients. Background Percutaneous MV repair is a potential treatment option for high-risk patients with severe mitral regurgitation (MR). Methods MitraClip (R) was implanted in patients with symptomatic MR rejected to conventional surgery. Differences between patients that survived at follow-up and patients deceased were tested. A stepwise Cox multivariate analysis was performed to identify independent predictors for composite endpoint of mortality, cardiac re-hospitalization, re-intervention, and major cerebro-vascular and cardiac events. Results A total of 85 consecutive patients [78 +/- 6 years, 48 (56.5%) men] with severe MR were included. There was no operative mortality while in-hospital mortality was 3.5% (n = 3) and 30-day mortality 4.7% (n = 4). Follow-up was 211 +/- 173 days. Survival and composite endpoint-free survival at one year were 71% and 55%. Multivariate analysis revealed that residual MR immediately after MitraClip (R) placement (OR 7.4; 95% CI 2.323.7) and preoperative MV gradient (OR 2.7; 95% CI 1.55.0) were predictors for composite endpoint. Chronic obstructive pulmonary disease (OR 8.3; 95% CI 1.937.1) was an additional predictor for composite endpoint. Conclusion MitraClip (R) is a valid tool with favorable outcomes in high-risk patients. The degree of residual MR seems to impact on follow-up composite endpoint outcome. An optimal correction of MR after MitraClip placement could be advocated to optimize the benefits of the procedure and minimize the risk of adverse outcomes. (c) 2012 Wiley Periodicals, Inc.