Predictors for efficacy of percutaneous mitral valve repair using the MitraClip system: the results of the MitraSwiss registry

Daniel Sürder, Giovanni Pedrazzini, Oliver Gaemperli, Patric Biaggi, Christian Felix, Kaspar Rufibach, Christof Auf der Maur, Raban Jeger, Peter Buser, Beat A Kaufmann, Marco Moccetti, David Hürlimann, Ines Bühler, Dominique Bettex, Jacques Scherman, Elena Pasotti, Francesco F Faletra, Michel Zuber, Tiziano Moccetti, Thomas F Lüscher, Paul Erne, Jürg Grünenfelder, Roberto Corti
Heart 2013, 99 (14): 1034-40

BACKGROUND: Percutaneous mitral valve repair (MVR) using the MitraClip system has become a valid alternative for patients with severe mitral regurgitation (MR) and high operative risk.

OBJECTIVE: To identify clinical and periprocedural factors that may have an impact on clinical outcome.

DESIGN: Multi-centre longitudinal cohort study.

SETTING: Tertiary referral centres.

PATIENTS: Here we report on the first 100 consecutive patients treated with percutaneous MVR in Switzerland between March 2009 and April 2011. All of them had moderate-severe (3+) or severe (4+) MR, and 62% had functional MR. 82% of the patients were in New York Heart Association (NYHA) class III/IV, mean left ventricular ejection fraction was 48% and the median European System for Cardiac Operative Risk Evaluation was 16.9%.

INTERVENTIONS: MitraClip implantation performed under echocardiographic and fluoroscopic guidance in general anaesthesia.

MAIN OUTCOME MEASURES: Clinical, echocardiographic and procedural data were prospectively collected.

RESULTS: Acute procedural success (APS, defined as successful clip implantation with residual MR grade ≤2+) was achieved in 85% of patients. Overall survival at 6 and 12 months was 89.9% (95% CI 81.8 to 94.6) and 84.6% (95% CI 74.7 to 91.0), respectively. Univariate Cox regression analysis identified APS (p=0.0069) and discharge MR grade (p=0.03) as significant predictors of survival.

CONCLUSIONS: In our consecutive cohort of patients, APS was achieved in 85%. APS and residual discharge MR grade are important predictors of mid-term survival after percutaneous MVR.

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