Riparazione percutanea della valvola mitrale con Mitraclip nei pazienti con scompenso cardiaco avanzato e insufficienza mitralica funzionale: impatto clinico ed effetti sul rimodellamento cardiaco e sul profilo neurormonale.

The role of percutaneous mitral valve repair (PMVR) in patients with advanced heart failure (HF) and functional mitral regurgitation (FMR) is unclear. The aim of this study was to assess the effects (PMVR) therapy on clinical outcomes , left ventricular (LV) remodeling and neurohormonal changes in inoperable critical patients with chronically symptomatic FMR despite optical medical /electrical therapy and severe LV dysfunction. We analyzed the clinical and echocardiographic data of twenty-five consecutive patients with FMR grade ≥3+ and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA). All patients had been judged inoperable because of severe LV dysfunction and/or comorbidities. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month follow-up. Mean age was 64±14 years, logistic EuroSCORE=29±19%. In three patients (12%) PMVR had been performed as a bridge to heart transplant, 10 (40%) were dependent from iv diuretics, and 6 (24%) needed iv inotropes. LV ejection fraction (EF) was 31±7%, LV end-diastolic volume (EDV) 201±53 ml. No serious periprocedural complication occurred; 19 patients (76%) were discharged with MR ≤2+. At 6-month, 1 patient died (4%), 77% had MR≤2+ and 68% were in New York Heart Association class ≤ II. Median pro-BNP decreased from 4395 pg/mL at baseline to 2594 pg/mL (p=0.003). There were no significant changes in LVEDV (195±53 ml vs. 193±58, respectively, p=0.90), LV end-systolic volume (ESV) (134±49 ml vs. 134±51, p=0.54) and LVEF (32±7% vs. 32±7%, p=0.35). The number of hospitalizations for HF in comparison with the 6 months before PMVR were reduced from 1.05±1.10 to 0.3±0.7 (p=0.0009). We concluded that in extreme risk advanced HF patients with FMR, PMVR was associated with improved symptoms, reduced re-hospitalization and decreased pro-BNP level at 6 months, despite the lack of LV reverse remodeling.