The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Impact of aetiology of mitral regurgitation on outcome after Mitraclip: lessons learned from MitraSwiss Registry.

DOI: 10.4244/EIJ-D-19-00718

1. Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
2. Service of Clinical Epidemiology & Biometry, Policlinico San Matteo, Pavia, Italy
3. Division of Cardiology, Hirslanden Klinik, Zurich, Switzerland
4. Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Italy; Division of Cardiology, Azienda Sanitaria Locale TO 4, Ciriè, Italy
5. Division of Cardiovascular Surgery, University Hospital Zürich, Switzerland
6. Division of Cardiology, Kantonsspital Luzern, Switzerland
7. Division of Cardiology, University Hospital Basel, Switzerland
8. Division of Cardiology, Klinik Im Park, Zürich, Switzerland
9. Division of Cardiology, University Hospital Geneve, Switzerland
10. Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland; Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Italy
11. Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland; Department of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Italy, Switzerland
12. Division of Cardiology, Kantonsspital Aarau, Switzerland
13. Division of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

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Aims: The Swiss national registry on percutaneous mitral valve interventions was established in 2011 to monitor safety/ efficacy of percutaneous mitral valve repair (PMVR) with MitraClip. We report in-hospital, short and mid-term outcomes of all patients prospectively enrolled.

Methods and results:  Since 2011, MitraSwiss enrolled 1212 patients with moderate and severe MR of functional (FMR) or degenerative (DMR) etiology treated with PMVR in 10 centers. Pre-specified endpoints included clinical, echocardiographic and functional parameters with follow up planned up to 5 years. Outcomes are compared according to MR etiology. Acute procedural success was achieved in 91.5% of cases, with no differences between FMR and DMR and sustained good mid-term results. NYHA class and pulmonary pressure improved significantly in both cohorts. Cumulative probability of death at 5 years was 54% (95%CI 45-63) in FMR and 45% (95%CI 37-54) in the DMR  (HR=1.15, p=0.009). Age, anemia, impaired renal function and reduced left ventricular ejection fraction resulted as independent predictors of death at 5 years.

Conclusions: In a large contemporary cohort of non-surgical patients with severe MR, PMVR confirms its safety and effectiveness. At a mid-term follow up mortality and MACE are lower in DMR patients, though MR aetiology is not directly and independently associated with outcome.

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