Real Life Single-Center Experience with Percutaneous MitraClip Procedure

Background: MitraClip (MC) procedure is becoming an acceptable therapeutic alternative in high risk patients with mitral regurgitation (MR) due to functional (FMR) or degenerative (DMR) disease and suitable mitral anatomy.

Aim: We aimed to evaluate the results of MC at our institute among carefully selected patients.

Methods: Retrospective analysis of the medical records and echocardiography data.

Results: A total of 39 MC procedures in 37 patients (aged 75±12 years, 9 women) were performed. 24 patients had FMR (13 with restricted posterior leaflet and 11 with bilateral leaflet tethering), 12 had DMR (9 flail P2, with concomitant flail P1 or P2 in 3 of them, one isolated flail A2 and 2 isolated flail P3), and 1 patient had combined DMR+FMR. All patients had baseline moderate-severe (grade 5 out of 0-6) or severe (grade 6) MR. Immediate post-procedure MR was reduced to grade 2 (IQR = grades 1-3), with peak and mean mitral valve gradients of 9.1±3.5 and 3.2±2.1 mmHg respectively. Late follow-up MR increased to 3 (3-4) at 1 year F/U. 1-3 (median=2) mitral clips were deployed for each intervention. Follow-up median time was 23.1 (10.4-61.7 IQR) months and the 2-year survival rate was 71±9%. Peri-procedural (< 1 week) death and MC failure requiring re-do-MC was noted in 1 and 2 patients respectively. NYHA class was reduced from 4 (3-4 IQR) at baseline to 2 (2-3) at 1m F/U with subsequent plateauing at 3 (2-3) during later follow-up. Pulmonary pressure (SPAP) was reduced from 53 (47-65) to 42 (34-52) mmHg at 1 m F/U with subsequent plateauing at later follow-up.

Conclusions: MC in severe MR resulted in a modest improvement in functional status and pulmonary pressure with a small risk of immediate procedural complications. Outcomes appear encouraging considering the natural course of MR or of surgical intervention in similar patients.