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Predictors for efficacy of percutaneous mitral valve repair using the MitraClip system: the results of the MitraSwiss registry
  1. Daniel Sürder1,
  2. Giovanni Pedrazzini1,
  3. Oliver Gaemperli2,
  4. Patric Biaggi2,
  5. Christian Felix3,
  6. Kaspar Rufibach4,5,
  7. Christof auf der Maur6,
  8. Raban Jeger7,
  9. Peter Buser7,
  10. Beat A Kaufmann7,
  11. Marco Moccetti1,
  12. David Hürlimann2,
  13. Ines Bühler2,
  14. Dominique Bettex3,
  15. Jacques Scherman8,
  16. Elena Pasotti1,
  17. Francesco F Faletra1,
  18. Michel Zuber6,
  19. Tiziano Moccetti1,
  20. Thomas F Lüscher2,
  21. Paul Erne6,
  22. Jürg Grünenfelder8,
  23. Roberto Corti2
  1. 1Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
  2. 2Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
  3. 3Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
  4. 4Department of Biostatistics, Institute for Social and Preventive Medicine, University Zurich, Zurich, Switzerland
  5. 5Department of Biostatistics Oncology, Roche, Basel, Switzerland
  6. 6Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
  7. 7Department of Cardiology, University Hospital Basel, Basel, Switzerland
  8. 8Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Professor Roberto Corti, Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zürich 8091, Switzerland; Roberto.corti{at}usz.ch

Abstract

Background Percutaneous mitral valve repair (MVR) using the MitraClip system has become a valid alternative for patients with severe mitral regurgitation (MR) and high operative risk.

Objective To identify clinical and periprocedural factors that may have an impact on clinical outcome.

Design Multi-centre longitudinal cohort study.

Setting Tertiary referral centres.

Patients Here we report on the first 100 consecutive patients treated with percutaneous MVR in Switzerland between March 2009 and April 2011. All of them had moderate–severe (3+) or severe (4+) MR, and 62% had functional MR. 82% of the patients were in New York Heart Association (NYHA) class III/IV, mean left ventricular ejection fraction was 48% and the median European System for Cardiac Operative Risk Evaluation was 16.9%.

Interventions MitraClip implantation performed under echocardiographic and fluoroscopic guidance in general anaesthesia.

Main outcome measures Clinical, echocardiographic and procedural data were prospectively collected.

Results Acute procedural success (APS, defined as successful clip implantation with residual MR grade ≤2+) was achieved in 85% of patients. Overall survival at 6 and 12 months was 89.9% (95% CI 81.8 to 94.6) and 84.6% (95% CI 74.7 to 91.0), respectively. Univariate Cox regression analysis identified APS (p=0.0069) and discharge MR grade (p=0.03) as significant predictors of survival.

Conclusions In our consecutive cohort of patients, APS was achieved in 85%. APS and residual discharge MR grade are important predictors of mid-term survival after percutaneous MVR.

  • Valvular Disease

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