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The MitraClip therapy is a percutaneous edge-to-edge procedure (the only one currently available) derived from a surgical technique developed by Professor Alfieri in the early 1990s. This surgical technique, which consists of the suture of the free edges of the leaflets with the creation of a double valve orifice, has been reported as safe, effective and durable in experience hands.1 ,2 Despite not exactly reproducing the surgical technique—no concomitant annuloplasty is performed, whereas it has been shown that it improves early and long-term results—the MitraClip has emerged as a promising option for the treatment of both organic mitral regurgitation (OMR) and functional mitral regurgitation (FMR).
After the EVEREST I trial and registry had shown the safety, feasibility and efficacy of the MitraClip3 with immediate and significant haemodynamic improvement,4 the EVEREST II trial was conducted. The EVEREST II trial is a multicentre, randomised controlled trial designed to evaluate the safety and efficacy of MitraClip versus conventional surgery (repair or replacement).5 Eligible patients include those with symptomatic or asymptomatic moderate to severe (3+) or severe (4+) mitral regurgitation who were candidates for mitral valve surgery and cardiopulmonary bypass. According to the anatomical inclusion criteria, the primary regurgitant jet should originate from malcoaptation of the middle scallops of the anterior and posterior leaflets. Main anatomical exclusion criteria were a left ventricular ejection fraction of 25% or less and/or a left ventricular end-systolic diameter greater than 55 mm, a mitral valve orifice area less than 4 cm2, if a leaflet flail was present a width of the flail segment of 15 mm or greater or a flail gap of 10 mm or greater, if leaflet tethering was present a coaptation depth greater than 11 mm or a vertical coaptation length less than 2 mm, severe mitral annular calcification or evidence of calcification in …