Predictors for Efficacy of Percutaneous Mitral Valve Repair Using the MitraClip System: The Results of the MitraSwiss Registry

Study Questions:

What are the clinical and periprocedural factors that impact clinical outcome of patients undergoing mitral valve repair (MVR) using the MitraClip system?

Methods:

The authors evaluated the first 100 consecutive patients treated with percutaneous MVR in Switzerland between March 2009 and April 2011. All of them had moderate-severe or severe MR. Over one-half of the patients had functional MR (62%) and 82% of the patients were in New York Heart Association (NYHA) class III/IV. Acute procedural success (APS) was defined as successful clip implantation with residual MR grade ≤2+.

Results:

APS was achieved in 85% of patients. In-hospital mortality was 4%. Two patients had chordal rupture and worsening of MR with resultant need for surgical repair. Overall survival at 6 and 12 months was 89.9% (95% confidence interval [CI], 81.8-94.6) and 84.6% (95% CI, 74.7-91.0), respectively. On follow-up, five patients presented with single leaflet clip detachment, of which three patients underwent redo clipping 9-12 months after the initial intervention. In one patient, mitral valve replacement had to be performed because of severe mitral stenosis detected 3 months after the implantation of two clips. Reoperation rate at mid-term was 5%. APS (p = 0.0069) and discharge MR grade (p = 0.03) were significant predictors of survival.

Conclusions:

The authors concluded that percutaneous MVR is a safe and effective procedure.

Perspective:

Unlike percutaneous treatment of aortic stenosis or mitral stenosis, percutaneous treatment of MR has been more challenging, with many promising approaches failing to work in human studies. Of the percutaneous approaches for MR, the MitraClip device has undergone the most detailed clinical evaluation and this study demonstrates promising results, albeit in a small cohort. Larger trials are warranted to define the optimal patient population that benefits from this approach.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: Hospital Mortality, Follow-Up Studies, Mitral Valve Insufficiency, Heart Valve Prosthesis Implantation, Angioplasty, Balloon, Coronary, Registries, Reoperation, Heart Failure, Mitral Valve Stenosis, Switzerland, Confidence Intervals, Cardiac Surgical Procedures


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