Real-World Experience of MitraClip for Treatment of Severe Mitral Regurgitation - Compromise Between Mitral Regurgitation Reduction and Maintenance of Adequate Opening Area -

Background: Percutaneous edge-to-edge mitral valve repair with the MitraClip® was shown to be a safe and feasible alternative compared to conventional surgical mitral valve repair. Herein is reported our experience on MitraClip® for high-risk surgical candidates with severe mitral regurgitation (MR). Methods and Results: Patients with severe MR (3 or 4+) and high operative risk were considered for MitraClip® implantation. Device success was defined as placement of 1 or more MitraClips® with reduction of MR to ≤2+. Patients were followed up clinically and with echocardiography at 1 year. A total of 27 patients with severe MR (age, 74±12 years; 17 male; logistic EuroSCORE, 27±12; left ventricular ejection fraction, 40±17%) were treated. Fifty-six percent of MR was degenerative and 44% was functional. Device success was 93% with 14 patients receiving 2 clips. MR severity was reduced from 3.5±0.5 to 1.7±0.8 (P<0.001); New York Heart Association class improved from 3.1±0.4 to 2.0±0.8 (P<0.001). In 45% of functional and in 29% of degenerative MR patients, to avoid mitral stenosis, additional MitraClip® implantation was not attempted, with resultant transmitral mean gradient of 4.9±1.6 mmHg vs. 3.1±1.4 mmHg, respectively (P=0.01). Conclusions: MitraClip® was shown to be an effective and safe treatment for patients with both functional and degenerative MR. Inability to obtain a greater reduction of MR was the consequence of borderline transmitral gradient requiring a compromise to avoid mitral stenosis, particularly in the functional MR patients.