Mid-term repair durability after MitraClip implantation in patients with functional mitral regurgitation.

Abstract

BACKGROUND\nThe aim of this study was to identify variables that are associated with the durability of percutaneous repair of secondary mitral regurgitation at 6-month follow-up.\n\n\nMETHODS AND RESULTS\nThirty-five consecutive patients with functional mitral regurgitation scheduled for MitraClip implant were enrolled. Left ventricular (LV) volumes and function and mitral valve characteristics were assessed before and immediately after MitraClip implantation using three-dimensional transesophageal echocardiography. Five patients with an unsuccessful procedure were excluded. The other patients were subdivided according to repair durability: group 1 with a durable repair (19 patients, 65%) and group 2 with significant mitral regurgitation recurrence (11 patients, 35%). At baseline, group 1 patients had smaller and more elliptical mitral valve annulus (1055\u200a±\u200a241 vs. 1273\u200a±\u200a359\u200amm, P\u200a=\u200a0.02 and 125\u200a±\u200a11 vs. 117\u200a±\u200a16%, P\u200a=\u200a0.02), a smaller left atrial volume (54.1\u200a±\u200a26 vs. 71.5\u200a±\u200a20\u200aml, P\u200a=\u200a0.005) and lower systolic pulmonary artery pressure (38\u200a±\u200a11 vs. 49\u200a±\u200a12\u200ammHg, P\u200a=\u200a0.03). Baseline LV end systolic volume had a linear correlation with the 3D annulus area (P\u200a=\u200a0.048) and an inverse correlation with annulus ellipticity (P\u200a=\u200a0.021). Group 1 patients showed an increase in annulus ellipticity after MitraClip (125\u200a±\u200a17 vs. 141\u200a±\u200a23%, P\u200a=\u200a0.014).\n\n\nCONCLUSION\nPercutaneous mitral valve repair leads to a significant and stable mitral regurgitation reduction in a large number of patients. Annulus dimensions and remodeling as well as left atrial area and pulmonary hypertension seem to be associated with durability of the procedure.