Long-Term Outcome of Patients with Severe Biventricular Heart Failure and Severe Mitral Regurgitation after Percutaneous Edge-to-Edge Mitral Valve Repair

ObjectiveTo assess long-term outcome and parameters associated with poor and favorable outcome in patients with a left ventricular ejection fraction (LV-EF) 25% and severe mitral regurgitation (MR) after percutaneous edge-to-edge mitral valve repair (pMVR). BackgroundThere is no data on long-term outcome in this cohort of patients. MethodsWe analyzed all 34 patients with a LV-EF 25% and severe MR treated with pMVR in 2 university hospitals from 2009 to 2012. ResultsMitral regurgitation could be successfully reduced to grade 2 in 30 patients (88%). Long-term follow-up (up to 5 years) revealed a steep decline of the survival curve reaching 50% already 8 month after pMVR. In contrast, estimated survival of the remaining patients showed a favorable long-term outcome. Patients deceased during the first year presented with higher right ventricular tricuspid pressure gradient (RVTG) (44.58.4mmHg vs. 35.2 +/- 15.4mmHg, P=0.035) and worse RV-function (P=0.014) prior to the procedure. One-year mortality of patients with pulmonary hypertension and depressed RV-function (n=22) was very high (77%) compared to the remaining patients (n=12, mortality rate of 0%, P=0.0001). ConclusionsAlthough pMVR lead to a successful reduction of MR in patients with a LV-EF 25%, 1-year mortality in this cohort was very high. However, a subgroup of patients showed a favorable long-term outcome after pMVR. Especially the right ventricular parameters sustained RV-function and absence of pulmonary hypertensioneasily assessed with echocardiographymight be used to identify this subgroup and encourage pMVR in these patients.