Abstract 11458: Temporal Changes in Mitral Regurgitation After Percutaneous Mitral Valve Repair with MitraClip for Functional Mitral Regurgitation in Patients with Atrial Fibrillation

Abstract

Background: Recently, percutaneous mitral valve (MV) repair has been increasingly performed for functional mitral regurgitation (FMR). However, few studies have examined the effectiveness of percutaneous MV repair for atrial FMR (AFMR). The aim of this study is to compare the effectiveness of MitraClip implantation between patients with AFMR and ventricular FMR (VFMR). Methods: We retrospectively reviewed 113 grade 3 to 4+ FMR patients with persistent atrial fibrillation or atrial flutter who underwent MitraClip implantation. We classified the patients into 2 groups; 43 patients with preserved left ventricular (LV) ejection fraction (LVEF) ≥ 50% and normal LV wall motion were defined as AFMR. 70 patients with LV dysfunction (LVEF < 50 %) or LV wall motion abnormality were defined as VFMR. Transthoracic echocardiography (TTE) follow-up was performed at approximately 1-day, 1-month and 1-year after the procedure. Results: The percentage of grade 4+ mitral regurgitation (MR) was 53% in AFMR and 49% in VFMR at baseline (P=0.61). Acute procedural success rate was similar between AFMR and VFMR (95.3% vs. 97.1%, P=0.49). The median period of 1-month and 1-year follow-up TTE were 33 [interquartile range (IQR): 28-36] days and 356 (IQR: 248-399) days in AFMR, and 34 (IQR: 30-38) days and 366 (IQR: 336-415) days in VFMR, respectively. The percentage of grade 3 or 4+ MR at 1-day, 1-month, and 1-year after the procedure were 4.7% (2/43), 10% (3/30), and 5.6% (1/18) in AFMR, and 2.9% (2/70), 7.3% (4/55), and 2.9% (1/35) in VFMR (P=0.49, 0.48, and 0.57, respectively, AFMR vs. VFMR at the same follow-up point). The rates of redo MitraClip or MV surgery for recurrent MR within 1-month and between 1-month/1-year were 0% and 9.3% in AFMR, and 1.4% and 1.4% in VFMR. The percentage of New York Heart Association functional class III or IV at baseline, 1-month, and 1-year after the procedure were 90.7% (39/43), 23.3% (7/30), and 33.3% (6/18) in AFMR and 97.1% (68/70), 27.3% (15/55), and 22.9% (8/35) in VFMR (P=0.15, 0.69, and 0.41, respectively, AFMR vs. VFMR at the same follow-up point). Conclusions: In our series, MitraClip implantation had comparable therapeutic effect on both MR severity and heart failure symptoms between patients with AFMR and VFMR.