Clinical Research
Percutaneous Edge-to-Edge Mitral Valve Repair in High-Surgical-Risk Patients: Do We Hit the Target?

https://doi.org/10.1016/j.jcin.2011.09.013Get rights and content
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Objectives

This study sought to assess the feasibility and safety of percutaneous edge-to-edge mitral valve (MV) repair in patients with an unacceptably high operative risk.

Background

MV repair for mitral regurgitation (MR) can be accomplished by use of a clip that approximates the free edges of the mitral leaflets.

Methods

All patients were declined for surgery because of a high logistic EuroSCORE (>20%) or the presence of other specific surgical risk factors. Transthoracic echocardiography was performed before and 6 months after the procedure. Differences in New York Heart Association (NYHA) functional class, quality of life (QoL) using the Minnesota questionnaire, and 6-min walk test (6-MWT) distances were reported.

Results

Fifty-five procedures were performed in 52 patients (69.2% male, age 73.2 ± 10.1 years, logistic EuroSCORE 27.1 ± 17.0%). In 3 patients, partial clip detachment occurred; a second clip was placed successfully. One patient experienced cardiac tamponade. Two patients developed inguinal bleeding, of whom 1 needed surgery. Six patients (11.5%) died during 6-month follow-up (5 patients as a result of progressive heart failure and 1 noncardiac death). The MR grade before repair was ≥3 in 100%; after 6 months, a reduction in MR grade to ≤2 was present in 79% of the patients. Left ventricular (LV) end-diastolic diameter, LV ejection fraction, and systolic pulmonary artery pressure improved significantly. Accompanied improvements in NYHA functional class, QoL index, 6-MWT distances, and log N-terminal pro–B-type natriuretic peptide were observed.

Conclusions

In a high-risk population, MR reduction can be achieved by percutaneous edge-to-edge valve repair, resulting in LV remodeling with improvement of functional capacity after 6 months.

Key Words

MitraClip
percutaneous mitral valve repair
severe mitral regurgitation

Abbreviations and Acronyms

6-MWT
6-min walk test
LA
left atrial/atrium
LV
left ventricular/ventricle
LVEDD
left ventricular end-diastolic diameter
LVEDV
left ventricular end-diastolic volume
LVEF
left ventricular ejection fraction
LVESD
left ventricular end-systolic diameter
MR
mitral regurgitation
MV
mitral valve
NT-proBNP
N-terminal pro–B-type natriuretic peptide
NYHA
New York Heart Association
QoL
quality of life
RA
right atrial
RVSP
right ventricular systolic pressure
TEE
transesophageal echocardiography

Cited by (0)

Drs. Swaans and Van der Heyden are faculty members/proctors for Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.