TRATTAMENTO PERCUTANEO CON SISTEMA MITRACLIP DELLA INSUFFICIENZA MITRALICA FUNZIONALE NEI PAZIENTI CON DISFUNZIONE VENTRICOLARE SINISTRA

Abstract

Background: Functional mitral regurgitation (FMR) is a poor prognostic idex in patients with dilatative cardiomyopathy. Surgical valve repair or replacement are frequently demed to high risk. Object: to assess the feasibility of catheter-based mitral valve repair using the MitraClip system in high-surgical-risk patients with FMR. Methods Forty-one patients (median age 68, male 88%) with FMR were subject for the Mitraclip treatment. The selection criterion consisted of 4 degree central localization MR due to simmetrical tethering of mitral leafletswithout loss of coaptation (coaptation lenght ≥ 2mm). Results A clip was successfully implanted in 40 patients (97,5%), two clips in 26 patients and three clips in 3 patients. Partial clip detachment occurred in two pts The median device implantation time was 83 min. A total 40 of 41 patients were treated. Freedom from clip embolization was 100%. Overall, 70% patients achieved acute procedural success, and 51 (64%) were discharged with FMR of 1. A total of 40 of 41 successfully treated patients were free from death, mitral valve surgery. Compared with baseline, left ventricular diameters, diastolic left ventricular volume, significantly diminished at follow-up. And left ventricular ejection fraction (EF%) were significantly improved compared to baseline: EF% increased from 28.24±1.68% to 35.68±1.79% and during 30days follow-up EF% 32.61±1.84 pre-post: p=0.003 pre-fup:p=0.008 post-fup: p=0.23. Thirty- eight pts were in NYHA Class 2 or better at 30d follow-up. Conclusions Percutaneous repair with the MitraClip system can be accomplished with low rates of morbidity and mortality and with acute MR reduction in the majority of patients, and with sustained freedom from death, surgery, or recurrent MR in a substantial proportion. Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to-edge mitral valve repair is feasible and may be accomplished with favourable short-term safety and efficacy results.