Plastie mitrale percutanée dans l’IM organique dégénérative par mitraclip ou neochord: étude observationnelle monocentrique

Abstract

High risk patients with degenerative mitral regurgitation who are contraindicated for surgery may now benefit from minimally invasive techniques. We aimed to evaluate the efficiency and safety of 2 recent techniques: Mitraclip, an edge-to-edge suture by endovascular access, and Neochord, a transpical implantation of artificial chordae tendinae. Patients with severe mitral degenerative regurgitation were included at the University Hospital of Montpellier, with clinical and echocardiographic follow-up performed at baseline and at 6 months. The primary endpoint of the study evaluated success of the procedure (defined as residual MR grade ≤ 2) and evolution of the NYHA functional class. Secondary endpoints included several echocardiographic parameters. Between January 2016 and October 2018, 26 patients were evaluated, 22 of them in the Mitraclip group and 4 in the NeoChord group. In the Mitraclip group, the procedure was successful in 15/22 patients (69%), with one death and one implantation failure observed. An improvement of NYHA functional class occurred in all patients with successful procedure. We observed a decrease of the left ventricular end-diastolic volume from 110 to 103 mL ( P = 0.005), and of the left ventricular end-diastolic diameter from 55 to 50 mm ( P = 0.001). The peak pressure gradient between the right ventricle and right atrium decreased from 59 to 40 mmHg ( P = 0.002). Conversely, there was no improvement of primary endpoint in the NeoChord group, with even a worsening of the NYHA stage and the MR severity for 3/4 patients. In the Mitraclip group, MR severity was significantly reduced in 69% of patients, leading to functional improvement when successful. The NeoChord technique seems quite disappointing, but is still to be evaluated in the long term on a larger scale. The Mitraclip is an alternative for high-risk patients contraindicated for surgery, with an acceptable success rate in this study.