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Percutaneous Mitral Valve Repair with Mitraclip System in Patients with Severe Left Ventricular Dysfunction: Safety and Outcomes
Laura Sanchis, Xavier Freixa, Marco Hernández-Henríquez, Ander Regueiro, Manel Sabate, Marta Sitges.
Hospital Clinic Barcelona, Barcelona, Spain.

OBJECTIVE: Outcomes of isolated surgical correction of mitral regurgitation (MR) in patients with low left ventricular ejection fraction (LVEF) have been poor and partially related to potential afterload increase and transient myocardial dysfunction. Our objective was to evaluate the echocardiographic evolution and outcomes of patients with low (≤30%) LVEF treated with percutaneous mitral reparation with Mitraclip.
METHODS: Patients with severe MR and low LVEF (≤30%) who underwent Mitraclip implantation and had a favourable final result of MR≤ grade II/IV were included. Transthoracic echocardiograms performed previously to implantation, 24h after and at 1 year follow-up were analyzed. Hospital admission due heart failure (HF), cardiac death and NYHA functional class before and one year after the implantation were recorded.
RESULTS: Forty out the 60 patients with Mitraclip implantation during the screened period had low LVEF (<30%) and severe MR. Among them, 27 (11 LVEF≤20%, 16 LVEF 20-30%) the result was MR≤ grade II/IV and were included for analysis (mean age 68.9±10.1yo). There were no procedural complications and patients could be discharged at 3.6±3.1 days. The year before Mitraclip implantation, 16 patients (59.2%) had at least 1 hospital admission due to HF (range 1-5 hospitalizations/patient, total 34) and 26 patients (96.3%) were in NYHA FC III-IV. One year after implantation, only 3 patients (11.1%) had one hospital admission due to HF, 2 patients had cardiac death (5th and 11th month) and one patient underwent heart transplantation (9th month).Most of patients (N=17, 63%) were in NYHA FC I-II. Table summarizes the echocardiographic evolution at 1 year follow-up, despite no significant reverse remodeling was observed, significant improvement in estimates of pulmonary artery pressure were shown.
CONCLUSIONS: MR correction with Mitraclip in patients with reduced LVEF seems to be safe and useful in reducing cardiac filling pressures and hospital admissions due to HF and improving NYHA FC.

Echocardiographic measurements
Basal24h after MitraclipP (basal vs. 24/48h)Follow-upP (basal vs. follow-up)
N272124
LVEF (%)22.9±5.023.5±6.70.09323.8±4.80.687
LV diastolic diamenter (mm)68.6±8.067.6±6.90.13568.2±8.90.837
LV diastolic vvolume (ml)223.7±88.3227.9±104.90.807219.3±88.50.873
LA volume (ml)117.3±46.8115.6±40.40.210107.5±32.10.257
Peak tricuspid regurgitation(m/s)3.2±0.52.8±0.40.0232.7±0.50.003


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