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      MitraClip® therapy in patients with end-stage systolic heart failure.

      European Journal of Heart Failure

      epidemiology, Ventricular Dysfunction, Left, Treatment Outcome, Stroke Volume, Prostheses and Implants, blood, Peptide Fragments, Natriuretic Peptide, Brain, ultrasonography, therapy, physiopathology, mortality, Mitral Valve Insufficiency, Middle Aged, Male, Kaplan-Meier Estimate, Humans, Heart Failure, Female, Feasibility Studies, Comorbidity, Aged

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          To assess the feasibility, short-term durability and clinical outcomes of MitraClip® therapy for mitral regurgitation (MR) in patients with end-stage heart failure and a severely reduced left ventricular (LV) ejection fraction. We analysed retrospectively collected data from seven European centres. Included in the study were 50 heart failure patients [mean age 70 ± 11 years, 38 men (76%)] with a LV ejection fraction ≤25% and MR of at least grade 3+. All patients had functional MR, were in New York Heart Association (NYHA) functional class III or IV, and their mean logistic EuroSCORE was 34%. The patients underwent a total of 53 MitraClip® procedures; one or more clips were implanted in 50 procedures (48 patients), for an acute procedural success rate of 94%. Severity of MR was reduced in all successfully treated patients, 44 (92%) were discharged with MR ≤2+. Thirty-day mortality was 6%; cumulative survival at 6 months was 81.2%. Clinical and echocardiographic 6-month follow-up data were obtained from 32 and 31 successfully treated patients, respectively. At 6 months, MR ≤2+ was present in 27 (87%) of 31 patients, and 23 (72%) of 32 patients were in NYHA functional class I or II. Six-minute walk distance improved significantly, and significant reductions in LV volumes indicative of reverse LV remodelling were concordant with significant reductions in N-terminal pro-brain natriuretic peptide plasma levels. MitraClip® therapy reduces functional MR in patients with end-stage heart failure and marked LV dysfunction and entails clinical benefit at 6 months.

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