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Objectives
Corrective surgery for functional mitral regurgitation (FMR) by restrictive annuloplasty has proven beneficial in that it improves NYHA functional class and induces reverse left ventricular remodeling. However, proof of a survival benefit for such patients is still pending. Percutaneous techniques of mitral valve repair (MVR) may become a viable treatment alternative for high-risk patients with severe FMR.
Methods
We retrospectively analyzed our prospective hospital database of patients with severe FMR undergoing either percutaneous treatment using the MitraClipTM device or surgical MVR. Patient characteristics and 6-month hemodynamic and clinical outcomes are reported.
Results
From March 2002 trough June 2010, 95 patients were treated using the MitraClipTM device while 76 patients underwent isolated surgical MVR for FMR at our center. Patients undergoing MitraClipTM treatment were significantly older (mean 72.8±8.2 vs 64.5±11.4 years, p<0.0001), tended to have a lower left ventricular ejection fraction (mean 36.2±12.5% vs. 40.4±15.3%, p=0.82), and were generally more high-risk, with a significantly higher mean logEuroSCORE compared to surgical candidates (33.7±18.7 vs. 10.3±8.7%, p2+ at 180 days was 85.7% (54/63) after successful MitraClipTM therapy and 94.7% (72/76) after MVR (p=0.08).
Conclusions
In our experience, characteristics and risk factors of patients with severe FMR undergoing surgery differ significantly from those considered for percutaneous therapy. At 6 months, surgery tended to be more effective compared to MitraClipTM in reducing MR. However, a large proportion of patients benefits from percutaneous intervention with sustained MR <2+ at 6 months. Especially for elderly patients with relevant comorbidities, MitraClipTM therapy seems to be an adequate alternative to surgery. Assessment, treatment and postprocedural care of patients by an interdisciplinary team is of paramount importance for clinical success.