180 * MITRACLIP THERAPY IN HIGH-RISK AND ELDERLY PATIENTS WITH DEGENERATIVE MITRAL REGURGITATION: MID-TERM CLINICAL AND ECHOCARDIOGRAPHIC OUTCOMES IN A SINGLE-CENTRE EXPERIENCE

Abstract

Objectives: To report mid-term outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with degenerative mitral regurgitation (DMR). Methods: From October 2008, the data of all high-risk or elderly patients with severe DMR who underwent MitraClip implantation were prospectively collected. All patients underwent standardized assessment of mitral valve anatomy and functional status by a dedicated Heart Team. Results: Forty-two consecutive high-risk patients (mean age 78.3 +/- 10.9 years, 53% older than 80 years) were treated; 70% of the patients were in NYHA class III-IV; STS score was 11.1 +/- 9.6%. Mean ejection fraction (EF) was 57.7 +/- 11% and left ventricular end diastolic diameter (LVEDD) was 57.2 +/- 8.6 mm. Procedural success was 98%, procedural time was 114.9 +/- 55 min, and in-hospital mortality was 2.3% (1/42 patients). Adverse events included intra-aortic balloon pump support (2.3%), renal replacement therapy (2.3%), major infections/ sepsis (2.3%), conversion to open heart surgery (2.3%), and need for blood transfusions (4%). No cerebrovascular events or acute myocardial infarction occurred. Length of stay was 4.6 +/- 2 days. At discharge, 90% of the patients had MR < 2+. At 12 months, EF was 55.5 +/- 10.6% and LVEDD was 53.9 +/- 7.5 mm. Actuarial survival was 89.7 +/- 4.8% and 70.6 +/- 9.6% at 1 and 2 years, respectively . Freedom from MR > 3+ was 79.4 +/- 7% and 66.9 +/- 8.9 at 1 and 2 years, respectively. Quality of life improvement was documented at 1 year with MLHFQ (from 33.6 to 18.4, P < 0.0001). Preoperative NYHA class IV was identified as predictive of death at follow-up (HR 7.5, P = 0.01). Conclusions: MitraClip therapy is a valuable alternative to surgery in high-risk and elderly patients with DMR. Although patients treated in current practice are high-risk, the procedure remains very safe and effective in selected patients.