Percutaneous Mitral Valve Repair for Mitral Regurgitation: the Initial Kaplan Medical Center Experience

Background: A significant number of patients with severe symptomatic mitral regurgitation(MR) are at a very high risk for valve surgery. The percutaneous MitraClip technique has been shown to be an effective and safe alternative to surgery.

Aim: To explore the clinical features and outcome of patients who underwent MitraClip procedure in our institute.

Methods: Fourteen patients underwent MitraClip procedure (age 75± 8), and followed up to 12 months. The clinical, echocardiographic data of 12 patients and functional assessment (6MW) and MQOL were recorded.

Results: All patients were at high risk for surgery with mean EuroSCORE ≥20, NYHA class III-IV, mean LVEF 36±14%(5<20%) and 80% had functional MR. Seven patients (50%) were on continuous IV decongestive therapy, all of whom had at least-2 hospitalizations for heart failure (HF) during 6 month before the procedure. Procedural success was achieved in all but 2 patients, with no periprocedural complications. 30% of the patients required an implantation of 2 clips. The achieved degree of MR immediately after procedure was ≤2 in 80% of the patients.

At 6 months follow-up all patients remained with MR ≤2, 4 of whom remained with elevated mean gradient (5.5-7.0 mmHg). No significant changes in either LVEF or PHT were obtained. However, all improved with regard to the NYHA class(≥1). The number of hospitalizations due to HF exacerbation decreased from 48 to 8 (p<0.003). No patient required IV therapy, with improvement of MQOL (from 55±27 to 30±23, p=0.02). There were 2 deaths at 7 and 11 months: one due to right sided failure and sepsis and another following LVAD implantation.

Conclusion: In high risk patients with HF and significant MR, MitraClip was safe in our initial experience and resulted in clinical improvement of quality of life and a decrease in hospital admissions regardless of changes in LV function and PHT.