Percutaneous mitral valve repair in the initial EVEREST cohort: evidence of reverse left ventricular remodeling

Elyse Foster, Damon Kwan, Ted Feldman, Neil J Weissman, Paul A Grayburn, Allan Schwartz, Jason H Rogers, Saibal Kar, Michael J Rinaldi, Peter S Fail, James Hermiller, Patrick L Whitlow, Howard C Herrmann, D Scott Lim, Donald D Glower
Circulation. Cardiovascular Imaging 2013, 6 (4): 522-30

BACKGROUND: Percutaneous repair of mitral regurgitation (MR) permits examination of the effect of MR reduction without surgery and cardiopulmonary bypass on left ventricular (LV) dimensions and function. The goal of this analysis was to determine the extent of reverse remodeling at 12 months after successful percutaneous reduction of MR with the MitraClip device.

METHODS AND RESULTS: Of 64 patients with 3 and 4+ MR who achieved acute procedural success after treatment with the MitraClip device, 49 patients had moderate or less MR at 12-month follow-up. Their baseline and 12-month echocardiograms were compared between the group with and without LV dysfunction. In patients with persistent MR reduction and pre-existing LV dysfunction, there was a reduction in LV wall stress, reduced LV end-diastolic volume, LV end-systolic volume and increase in LV ejection fraction in contrast to those with normal baseline LV function, who showed reduction in LV end-diastolic volume, LV wall stress, no change in LV end-systolic volume, and a fall in LV ejection fraction.

CONCLUSIONS: Patients with pre-existing LV dysfunction demonstrate reverse remodeling and improved LV ejection fraction after percutaneous mitral valve repair.

CLINICAL TRIAL REGISTRATION: URL: Unique identifiers: NCT00209339, NCT00209274.

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