Clinical outcomes of MitraClip for the treatment of functional mitral regurgitation

Aims: The aim of this study was to report medium-term outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with functional mitral regurgitation (FMR) in our single-centre experience. Methods and results: From October 2008, 109 consecutive patients with FMR underwent MitraClip implantation (mean age 69 +/- 9 years; 82% NYHA Class III-IV). Logistic EuroSCORE was 22 +/- 16%. Comorbidities included: chronic renal failure (47%), diabetes (22%), COPD (28%). Mean EF was 28 +/- 11%; LVEDD was 68 +/- 8 mm. Procedural success was 99% and 30-day mortality was 1.8%. At discharge, 87% patients had MR <= 2+. At 12 months, EF was 34.7 +/- 10.4% (p=0.002 compared to preoperative value). Actuarial survival at three years was 74.5 +/- 7%. Actuarial freedom from MR >= 3+ at 2.5 years was 70 +/- 6%. At one-year follow-up, 86% of patients were in NYHA Class I-II. Preoperative pro-BNP level >= 1,600 pg/ml was identified as an independent risk factor of mortality at follow-up. Conclusions: MitraClip therapy for FMR is a valuable alternative to surgery in high-risk patients. Higher preoperative pro-BNP level is a risk factor for mortality at follow-up. Although patients treated in current practice are high-risk, the procedure remains safe and effective in selected patients. OI Denti, Paolo/0000-0002-3075-0203