Thorac Cardiovasc Surg 2014; 62 - OP104
DOI: 10.1055/s-0034-1367178

Percutaneous mitral valve repair using the MitraClip system: large single-center experience in 400 consecutive patients not amenable to surgery

J. Schirmer 1, B. Goldmann 2, L. Conradi 1, M. Schlüter 2, E. Lubos 2, M. Seiffert 2, S. Baldus 2, H. Treede 1, S. Blankenberg 2, H. Reichenspurner 1
  • 1Universitäres Herzzentrum Hamburg, Klinik für Herz- und Gefäßchirurgie, Hamburg, Germany
  • 2Universitäres Herzzentrum Hamburg, Klinik für Allgemeine und Interventionelle Kardiologie, Hamburg, Germany

Objectives: To date, percutaneous mitral valve repair using the MitraClip system is the most widely used catheter-based strategy to treat mitral regurgitation (MR). We report clinical and functional outcome after MitraClip therapy in patients ineligible for surgery due to contraindications or excessive operative risk.

Methods: From 9/2008 through 4/2013, a total of 400 consecutive patients (age 75 ± 9 years; 61% male) with symptomatic functional (66%) or degenerative (34%) MR≥3 were treated with the MitraClip system adjudicated by heart team consensus. Risk for mitral valve surgery was considered high by a logistic EuroSCORE of 26 ± 18%. Pre-procedural left ventricular ejection fraction was reduced to 42 ± 16% (range 12-71%). Clinical and functional follow-up data were available in 360 patients with a median duration of 12 ± 9 months (range 0.3-47.9 months) following index procedure.

Results: Successful MitraClip implantation (residual MR ≤ 2 at discharge) was documented in 364 (91%) patients. Pre-procedural MR severity was grade 3 in 216 (54%) patients and grade 4 in 184 (46%) patients. Procedure-related reduction in MR severity was three grades in 56 (14%) patients, two grades in 216 (54%) patients, one grade in 107 (27%) patients, and remained unchanged in 21 (5%) patients. Thirty-day mortality was 3.6%, whilst one-year and two-year survival rates were 78.4% and 62.4%. Estimated freedom from reintervention at one year and at two years was 90.6% and 87.3%. Freedom from heart failure rehospitalisation at one year and at two years was 47.0% and 33.3%, respectively.

Conclusion: In the majority of patients, MitraClip therapy was safe and effective in durably reducing MR. However, overall mid- and long-term mortality and rehospitalisation reflect severity of the patients comorbidities and the natural course of the disease. Even though less effective in reducing MR compared to surgery, treatment with the MitraClip device has proven to be an important therapeutic option in selected patients who are inoperable or at prohibitive risk for cardiac surgery. Therefore, the MitraClip system represents an essential complementary tool for an integrated mitral valve program.