Percutaneous mitral valve repair: Initial experience with mitraclip™

Background: The aim of this study was to analyze and report the initial results of a series of patients with severe symptomatic mitral regurgitation (MR) and high surgical risk who underwent percutaneous mitral valve repair (PMVR) with MitraClip™. Methods: Twelve consecutive patients with severe symptomatic MR and high surgical risk or contraindication for surgery underwent PMVR with MitraClip™ between March 2016 and October 2018. Implant success was defined as adequate leaflet grasping, with mild or moderate residual MR at the end of the procedure, and 30-day procedural success as implant success without any major adverse cardiovascular event, including death, acute myocardial infarction (AMI), stroke, need for valve surgery, pericardial effusion, cardiac tamponade or major bleeding. All patients were in functional class III-IV and with history of previous hospitalizations due to heart failure. Echocardiographic findings were: left ventricular end-diastolic diameter (LVEDD): 61.8±6.4 mm, left ventricular end-systolic diameter (LVESD): 46.3±2.1 mm and left ventricular ejection fraction (LVEF): 47.5±13.4% (25-60%). The cause of MR was degenerative in 7 patients and functional in 5. Risk evaluation showed EuroSCORE of 9.6±6.8, Society of Thoracic Surgeons (STS) mortality score of 16.1±13.5 and STS morbidity and mortality score of 22.8±17.7 Results: Implant success was achieved in all patients; a single clip was implanted in 7 patients and 2 clips in 5. Mean post-implant residual gradient was 3.6±0.2 mmHg. Post-procedural MR was mild in 11 patients and trivial in one. Mean hospital stay was 1.9 ± 0.8 days (range 1-3 days). At 30 days all patients were in FC I-II and no patient presented major events or readmission for heart failure. Follow-up was performed in all patients for a mean period of 8.8±6.7 months (range1-30 months). Two patients died (1 from pneumonia 14 months after the procedure and another at 30 months due to refractory heart failure after transcatheter aortic valve implantation (TAVI), preserving mild MR. There were no other complications. All patients were in FC I-II, and one patient required readmission due to heart failure 7 months after the procedure. Echo Doppler at follow-up showed mild MR in 11 patients and moderate to severe MR in one. Quality of life improved in all patients. Conclusion: In this initial, single center series that includes the learning curve of the team, PMVR with MitraClip™ in patients with severe symptomatic MR and high surgical risk was safe and effective, with a significant clinical and quality of life improvement during follow-up.