Outcomes of Patients Turned Down for Percutaneous Mitral Valve Repair

Objectives: The aim of this study was to assess the reasons for and outcomes of patients who were declined percutaneous mitral valve repair (PMVR) using the MitraClip device and compare them with patients who underwent the procedure.

Background: Percutaneous MVR is an alternative treatment for high-risk patients with symptomatic mitral regurgitation (MR). Proper patient selection is crucial to ensure that patients will benefit from the procedure while avoiding futile and potentially harmful medical interventions.

Methods: Of 182 patients for PMVR, 84 were referred for MitraClip implantation and 75 underwent the procedure.

Results: Procedural success was achieved in 64 (85%) patients and was associated with superior survival at 30 months (73%) compared with implanted patients who did not achieve procedural success (41%) (p-value= 0.017). Ninety-eight patients were turned down for the procedure due to anatomical incompatibility (72%), lack of indication (“too well”) (16%), and clinical incompatibility (“too sick”) (12%). Among turned down patients, those who were deemed “too well” had the highest survival (85%) at 30 months, patients with anatomical incompatibility had intermediate survival rates (63%), while patients deemed “too sick” had a dismal survival rate of only 25% (p-value= 0.008) See attached graph. In fact, the “too well” patients had outcomes which were equivalent to patients who underwent successful MitraClip implantation.

Conclusions: We identified a number of reasons for not performing MitraClip implantation which impact patient survival. The best outcomes were seen in patients who underwent successful MitraClip implantation and in patients who were deemed “too well”.

kaplan meier curve- survival of patients turned down for MitraClip implantation