One year clinical efficacy and reverse cardiac remodelling in patients with severe mitral regurgitation and reduced ejection fraction after MitraClip implantation

Abstract

Aims: The aim of the present study was to investigate 1 year clinical and functional efficacy of percutaneous mitral valve (MV) repair using MitraClip in high-risk surgical patients with symptomatic severe MV regurgitation (MR) and reduced LVEF.

Methods and results: Between September 2009 and November 2011, 59 patients with reduced EF and severe MR received endovascular MV repair using MitraClip. Patients were characterized after 1 and 12 months using echocardiography, 6 min walk test distance, and cardiac biomarkers. The predicted 30-day surgical perioperative mortality rate was 11.4 ±2.2% using the Society of Thoracic Surgeons' score. Complete 1-year clinical follow-up was achieved in 70% of the patients (n = 41; EF 33 ±3%). Percutaneous MV repair resulted in significantly reduced MR and improved NYHA functional class, translating into significantly increased 6 min walk test distance, while high-sensitive troponin T (P < 0.05) and NT-proBNP (non-significant) were reduced. Echocardiography revealed structural reverse remodelling with significantly reduced left atrial volume and LV end-systolic diameter, as well as significantly increased LVEF. These results were consistent in a subgroup of patients with severely reduced LVEF (EF 23 ±2%; n = 25). Thirty-day mortality was 2.9%.

Conclusion: Percutaneous MV repair using MitraClip is a safe technique in high-risk surgical patients, causing significant 1 year reduction of MR which results in structural cardiac reverse remodelling and an increased LVEF. The present data encourage percutaneous MV repair in heart failure patients.

Keywords: Heart failure; MitraClip; Mitral valve regurgitation; Percutaneous edge-to-edge valve repair.