MitraClip Therapy for Patients with End-Stage Heart Failure: A Durable Option?

Objective: The aim of this study was to assess feasibility and clinical outcome of MitraClip^® therapy for mitral regurgitation (MR) in patients with end-stage heart failure and severely reduced left ventricular ejection fraction (LVEF) ≤ 25%.

Methods: We retrospectively analyzed our MitraClip database (n = 620) and included 93 end-stage heart failure patients (age 70.6 ± 8.8 years, 77.4% male (72/93)) with LVEF ≤ 25% and MR ≥ III° according to Mitral VARC endpoint definitions.

Results: The majority of patients 95.7% (89/93) had functional MR, 3.2% (3/93) mixed MR and 1.1% (1/93) degenerative MR. All patients were in New York Heart Association (NYHA) functional class III/IV, logistic EuroSCORE I was 26.3 ± 17.1%. Immediate interventional success rate was 97.8% (91/93). Successfully treated patients received one, two, > two clips in 54.9% (50/91), 36.3% (33/91) and 8.8% (8/91) respectively. 37.4% (34/91) of the patients were discharged with MR ≤ I°, 56.0% (51/91) with MR II° and 6.6% (6/91) with MR ≥ III°. 30-day mortality was 5.5% (5/91). Cumulative survival at 6, 12 and 24 months was 83.4%, 68.9% and 48.0% respectively. Clinical and echocardiographic 12-months follow-up was available from 46 patients. At 12 months, MR ≤ I° was still present in 34.8% (16/46), MR II° in 47.8% (22/46) and MR III/IV° in 17.4% (8/46) of the patients. 65.2% (30/46) of the patients were in NYHA functional class I/II at 12 months. Six-minute walk distance improved significantly from baseline to 12-months (221.9 ± 150.0 m vs. 264.9 ± 154.1 m, p = 0.02). Furthermore, a decrease of N-terminal pro-brain natriuretic peptide plasma levels was noted (9,545.1 ± 10,338.6 ng/L vs. 6,737.1 ± 8,299.5 ng/L, p = 0.11). No significant left ventricular remodeling or improvement of LVEF was observed: LVEDD 74.5 ± 9.5 mm vs. 75.7 ± 9.3 mm, p = 0.75; LVEF 19.3 ± 3.9% vs. 22.0 ± 8.2%, p = 0.07). In 5.5% (5/91) of the patients, repeat MitraClip intervention was necessary for recurrence of MR, an additional 2.2% (2/91) of the patients required secondary mitral valve surgery.

Conclusion: MitraClip therapy reduces MR in the majority of patients with end-stage heart failure and LV dysfunction with sustained clinical and hemodynamic results at 12 months. Careful patients selection seems crucial to ensure clinical and hemodynamic success at 12 months. Further studies are needed to better define subsets of heart failure MR patients in which therapeutic success seems likely.

No conflict of interest has been declared by the author(s).