MitraClip Therapy in Patients with Acute Severe Mitral Regurgitation

Anna Turyan Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Ivaylo Tonchev Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Ilgar Tahiroglu Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Chaim Lotan Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Dan Gilon Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel David Planer Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Haim D. Danenberg Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Ronen Beeri Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Mony Shuvy Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel

Background: The role of the MitraClip implantation in treatment of acute severe mitral regurgitation (MR) and refractory heart failure (HF) is undetermined.

Methods: We studied a cohort of 52 patients who underwent MitraClip implantation at the Hadassah Medical Center between October 2015 and December 2017. We evaluated immediate, 30-day and one-year outcomes after the procedure. We evaluated patients with acute severe MR due to ruptured cord because of degenerative disease and acute-on-chronic functional MR due to ischemic (after a recent myocardial infarction (MI)) or non-ischemic etiology (secondary to decompensated HF).

Results: Patients’ mean age was 73.16 years, 76.5% - were males. One, 2, or 3 clips were implanted. Reduction of MR from 4+ to 1+ was achieved in 34 patients (66.7%). Only 3 patients (5.8%) remained with severe MR after the procedure.

Nine patients (17.3%) had acute-on-chronic severe MR: 6 patients were presented with refractory heart failure including 3 cases after recent MI, other 3 patients presented with heart failure and severe MR secondary to ruptured cord due to degenerative disease.

Reduction of MR from 4+ to 1+was achieved in 4 patients (44.4%), to 2+ in 5 patients (55.6%).

Five patients were weaned from intravenous therapy and intra-aortic balloon pump 2-3 days after the procedure. Two patients died during hospitalization due to sepsis. 30-day and one-year outcome analysis showed higher mortality rate as compared to entire cohort (11.1% and 33.3% vs. 5.8% and 15.4%, respectively). Echocardiographic results showed a tendency toward improvement in left ventricle systolic function.

Conclusions: MitraClip therapy can be recommended for treatment of patients with acute and acute-on-chronic severe MR of ischemic and non-ischemic etiology.

Anna Turyan

hadassa