Long-Term Outcomes After MitraClip Implantation According to the Presence or Absence of EVEREST Inclusion Criteria

Abstract

Numerous patients are treated with the MitraClip, although they do not fulfill the stringent inclusion criteria of the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) trials. The outcome of those patients is not well known. Therefore, we compared the long-term outcome after MitraClip treatment between patients who matched (group 1) and did not match (group 2) the EVEREST criteria. One hundred thirty-four consecutive patients were treated from September 2009 to July 2012: 59 patients (44%) in group 1 versus 75 patients (56%) in group 2. Investigated end points were acute procedural success (for group 1 vs 2: 97% vs 95%; p= 0.694), all-cause mortality (28% vs 27%; p= 0.656), reintervention (RI) rate (11% vs 37%; p= 0.010), and improvement in mitral regurgitation (MR) (-1.3 ± 1 vs-1.5 ± 1, p= 0.221) and in New York Heart Association functional class (-0.7 ± 1 vs-0.9 ± 0.8, p= 0.253) during the follow-up of 33 months (27.9 to 38.3). The morphologic extent of a flail leaflet was an independent predictor for RI. In conclusion, although the overall outcome was comparable between both groups, recurrent symptomatic MR with need for RI was higher in group 2, mainly because of complex valve pathologies: especially flail width >15mm and gap ≥10mm. Improvements in the interventional strategy are warranted for reducing the need for RI in patients with primary MR.