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Functional Mitral Regurgitation (FMR) may cause Heart Failure (HF). Cardiac surgery for open correction of FMR in patients with severely impaired left ventricular ejection fraction (LVEF) or prior cardiac surgery entails higher risk. The EVEREST II Trial in patients who were surgical candidates for mitral valve repair showed outcomes of percutaneous repair using the MitraClip were comparable with surgery.
We hypothesized that MitraClip is safe and effective in patients with severe FMR and HF who are not surgical candidates.
We identified 4 patients with significant FMR and limited exercise capacity due to HF. Significant ischemia was excluded with functional imaging. Surgical risk was deemed prohibitive. Mitral valve anatomy was assessed by transthoracic (TTE) and transesophageal echocardiography.
One patient was female, 2 had AF, 3 had prior remote coronary artery bypass graft surgery, and the 4th had non-ischemic cardiomyopathy. Age was 59 ± 11 years, BSA 1.7 ± 0.1 m2, GFR 57.5 ± 46.9mls/min, Hemoglobin 11.2 ± 1.4g/dL. NYHA 2.75 ± 0.5, LVEF 30 ± 17%, MR grade 3.75 ± 0.5, Six-Minute Walk Distance (6MWD) 208 ± 132m, and Euroscore risk for cardiac surgery 32.9 ± 26.9%.
All patients underwent successful MitraClip procedures without complication. Three patients used 1 clip, while 1 patient required 2 clips. MR grade was reduced to 1.25 ± 0.5 and patients were discharged 2.25 ± 0.96 days post MitraClip. Follow-up TTEs show durability of MR reduction (Fig 1.). 6MWD improved to 423 ± 92m (p=0.037). Two patients have resumed working, and all can participate in normal activities of daily living. They remain on standard pharmacotherapy for heart failure.
In conclusion, MitraClip is safe and effective in restoring exercise capacity in selected patients with severe FMR and HF who are not surgical candidates.
- 2013 American College of Cardiology Foundation