MitraClip Therapy Reduces Pulmonary Hypertension and Improves Survival in Patients with Severe Mitral Regurgitation

Background: MitraClip implantation improves mitral regurgitation (MR). However, its impact on pulmonary hypertension (PHTN) has not been fully elucidated. Our hypothesis was that changes in pulmonary pressure after MitraClip implantation might predict outcomes.

Methods: We studied a cohort of 84 consecutive patients who underwent MitraClip implantation at the Hadassah Medical Center between August 2015 and September 2018. We evaluated echocardiographic data including PHTN, clinical data, and long- term outcomes.

Results: The mean age of the cohort was 74 ± 10 years, 75% were men, and 80% had functional MR. One (15%), two (66%), or three (19%) clips were implanted in each procedure. In 46% of the patients, PHTN was improved, in 33% there was no change, and in 21% PHTN was increased. On average, there was a significant reduction of the mean PHTN from 54.6 ± 14.5 mmHg before the procedure to 49.2 ± 13.2 after the procedure (P=0.002). This reduction was maintained at the 6-month follow-up. One-year survival rates were 91% among patients who showed reduction or stability of PHTN, and only 38% in patients who showed increased PHTN. Similarly, the estimated mean survival was significantly higher among patients who showed reduction or stability of PHTN compared with patients who showed increased PHTN (31 vs. 13 months, respectively, P=0.002). Kaplan-Meier survival curves showed significantly improved survival rates in the reduction and stability groups (P<0.001).

Conclusions: MitraClip therapy improves PHTN in patients with severe mitral regurgitation. In addition, PHTN improvement is associated with better survival.