Safety and feasibility of MitraClip implantation in patients with acute mitral regurgitation after recent myocardial infarction and severe left ventricle dysfunction

Mony Shuvy ¹ Rodrigo Estévez-Loureiro ² Tomas Benito-Gonzalez ³ Paolo Denti ⁴ Dabit Arzamendi ⁵ Marianna Adamo ⁶ Xavier Freixa ⁷ Luis Nombela-Franco ⁸ Pedro Villablanca Villablanca ⁹ Lian Krivoshei ¹⁰ Neil Fam ¹¹ Konstantinos Spargias ¹² Isaac Pascual ¹³ Andrew Czarnecki ¹⁴ Fabien Praz ¹⁵ Doron Sudarsky ¹⁶ Arthur Kerner ¹⁷ Vlasis Ninios ¹⁸ Marco Gennari ¹⁹ Ronen Beeri ²⁰ Leor Perl ²¹ Haim Danenberg ²² Lion Poles ¹ Jacob George ¹ Danny Dvir ²⁴ Francesco Maisano ²³ Maurizio Taramasso ²³ Mony Shuvy ²⁴

¹Heart Center, Kaplan Medical Center, Israel
²Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Spain
³Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, Spain
⁴Cardiovascular surgery department, San Raffaele University Hospital, Italy, Italy
⁵Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Spain
⁶Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Italy
⁷Interventional Cardiology Unit, Hospital Clinic De Barcelona, Spain
⁸Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Spain
⁹The Center for Structural Heart Disease, Henry Ford Hospital, USA
¹⁰Department of Cardiology, Kantonsspital Baden, Switzerland
¹¹Division of Cardiology, St. Michael's Hospital, University of Toronto, Canada
¹²Department of Transcatheter Heart Valves, HYGEIA Hospital, Greece, Greece
¹³Department of Cardiology, Hospital Universitario Central de Asturias, Spain
¹⁴Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
¹⁵Department of Cardiology, Inselspital, Bern University Hospital, Switzerland
¹⁶Cardiovascular Institute, Baruch Padeh Medical Center, Israel
¹⁷Department of Cardiology, Rambam Medical Center, Israel
¹⁸Department of Cardiology, Interbalkan European Medical Center, Greece
¹⁹Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Italy
²⁰Heart Institute, Hadassah-Hebrew University Medical Center, Israel
²¹Cardiology Department, Rabin Medical Center, Israel
²²Heart Center, Wolfson Medical Center, Israel
²³Heart Valve Clinic, University Hospital of Zurich, Switzerland
²⁴Jesselson Integrated Heart Centre, Shaare Zedek Medical Center,, Israel

Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle dysfunction. We conducted multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF) = 35%. 105 patients were included in the study. The mean age was 71±10 years. Patients in the LVEF<35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p=0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in NYHA class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p=0.51 and 19% vs. 12%, p=0.49), and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe FMR due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded.