Background: Percutaneous mitral valve repair with the Mitraclip system is a clinically available option for patients with severe mitral incompetence considered to be at very high surgical risk. This complex procedure has a significant learning curve. We aimed to assess the impact of experience on procedural competence in our center.
Methods: Outcomes of the first 31 patients treated with the MitraClip at our center were stratified according to an arbitrary initial treatment period (10 patients, group 1) and the second more experienced (17 patients, group 2). MR grading was based upon transthoracic echocardiograms prior to the procedure and predischarge. Intraprocedural echos were not used.
Results: Acute procedural success (clip successfully placed and mitral regurgitation grade ≤2 at discharge) was 70% in group 1 and 94% in group 2. Although the majority of patients treated suffered from functional MR (82%), degenerative MR was more frequent in group 2 (4pts, 23%) than group 1 (1pt, 10%). Two clips per procedure were more frequent in group 2 (5, 29%) vs group 1 (1,10%). In two patients the procedure was abandoned prior to transeptal puncture (unusual septal anatomy (group 1) and interrupted IVC (group 2). In two further cases (group1) no clip was released (no improvement in MR and esophageal hematoma). There was a single inhospital noncardiac death seen in successfully treated group 2 patient. In spite of the increasing number of clips per case device time reduced significantly from a mean total device time of 2.16±1.64 hrs in group 1 to 0.9±1.84 hrs in group 2 (p=0.54). Alternatively when the first five cases were compared with the rest of our experience the device time reduced from 2.94±2.00 to 1.72±0.8 hours (p=0.04)
Conclusion: With increasing experience using the Mitraclip system, more challenging cases were treated with increasing success rates and reduced procedural times.
