Objectives:
To determine the efficacy of the MitraClip device in the reduction of mitral regurgitation (MR) in patients with severe mitral valve insufficiency.
Background:
MR is a common disease for which the treatment of choice is a high-risk surgery. The MitraClip (Abbott Vascular-Structural Heart, Menlo Park, CA, United States) is a transcatheter edge-to-edge mitral valve repair method that aims to reduce MR with a less invasive procedure. It is currently the method of choice for the percutaneous repair of mitral regurgitation.
Method:
All the patients who benefited from the MitraClip procedure at the Centre Hospitalier Universitaire Vaudois (CHUV) between January 2017 and December 2019 were selected. The following data were collected from the patients’ records: patient characteristics and comorbidities, procedural complications, morbidity and mortality during hospitalization. The heart failure drugs prescribed for each patient at admission and at discharge were compared to evaluate clinical improvement. Echocardiographic parameters before and after the procedure were compared.
Results:
A total of 50 patients were included in the study. The MitraClip was successfully implanted in 94% of our cohort. The procedure was successful in the acute reduction of MR with a mean post-operative MR grade of 1.39 (p < 0.001). The left heart parameters showed an important decrease of the left ventricular ejection fraction (LVEF) (p < 0.001). The left ventricular end-diastolic diameter (LVEDD) and the left ventricular mass (LV mass) were significantly decreased (p-value 0.001 for both). There were no changes in the left ventricular end-diastolic volume (LVEDV) and the left ventricular end-systolic volume (LVESV). We found a significant increase in the left atrial volume after the procedure. There were no significant changes in the function and morphology of the right heart after the procedure. A low rate of periprocedural complications was found, with 0 procedural death, a 2% in-hospital mortality and a rate of major adverse cardiac and cerebrovascular events (MACCE) of 6% (in-hospital mortality, strokes and myocardial infarctions). However, we found no change in the heart failure drugs prescribed before and after the procedure.
Conclusion:
This study suggests that the MitraClip is effective in the acute reduction of MR in patients at high surgical risk, characterized by many comorbidities, with a low rate of adverse events. However, starting from the premise that the changes in heart failure drugs are indicative of the clinical benefit, we were unable to demonstrate a clinical benefit to the MitraClip procedure. The possibility of long-term clinical benefit should be assessed in a further study to determine if the frequent indication for the MitraClip procedure is justified.