Initial Slovenian experience with MitraClip therapy : Careful selection of patients is crucial for optimal outcome

Abstract

Background: MitraClip is a percutaneous mitral repair technology increasingly used for high surgical risk patients with primary or secondary mitral regurgitation. We describe initial Slovenian experience with MitraClip and discuss the importance of identifying the suitable candidates for this procedure.

Methods: We retrospectively analyzed the first 10 patients (mean age 75.6 ± 6.9 years, logistic Euroscore 28.4 ± 10.9%) with severe and moderate to severe mitral regurgitation (8 secondary, 1 primary and 1 mixed etiology) who underwent a MitraClip procedure between January 2015 and February 2017.

Results: Acute reduction of mitral regurgitation was achieved in all but one patient (90%). There were no periprocedural mortalities and at short to mid-term follow-up (median 12 months, interquartile range 3-15 months). In eight patients improvement of functional class was observed at discharge. No functional improvement was achieved in a patient with advanced ischemic cardiomyopathy, and in a patient with degenerative mitral disease in whom the MitraClip procedure had failed necessitating mitral valve surgery. One patient experienced late leaflet detachment and was effectively managed with a second MitraClip procedure. There were two vascular complications at the access site and one percutaneous closure of an iatrogenic atrial septal defect.

Conclusion: Our initial experiences with a small number of patients indicate that percutaneous mitral repair with MitraClip is a feasible and safe method in high-risk patients. Special attention should be paid to careful patient selection including detailed echocardiographic evaluation of mitral valve anatomy, technical performance and final result, particularly at the beginning of the learning curve in order to reduce the rate of serious complications.

Keywords: Echocardiography; MitraClip; Mitral anatomy; Mitral regurgitation; Percutaneous mitral valve repair.