Usefulness of Age (≥85 Years) and Residual Mitral Regurgitation (>1+/4+) for the Prediction of Adverse Outcomes in Patients Receiving the MitraClip.

The goal of this study was to determine the predictors of adverse clinical outcomes in patients treated with the MitraClip for significant mitral regurgitation (MR) with a focus on acute changes in hemodynamics and cardiac function. This retrospective study included 63 patients (mean age 82 +/- 8 years, 48% male) with moderate to severe or severe MR. Cardiac catheterization was performed before and immediately after MitraClip repair. Volumetric and functional changes were assessed in both ventricles. A major adverse cardiac event was defined as a composite of cardiac death and readmission for heart failure. Patients were followed up on average for 380 days. MR was improved in 92% of patients after MitraClip therapy from an average grade of 4+ to <2+ (p < 0.001). The pulmonary capillary wedge pressure decreased from 22 +/- 7 mm Hg to 19 +/- 6 mm Hg (p < 0.001), and the cardiac stroke volume increased by 28% from 102 +/- 53 ml to 131 +/- 54 ml (p < 0.001). The left ventricular end-diastolic volume was significantly reduced 24 hours after MitraClip therapy compared to that at baseline (p = 0.001). In the multivariate Cox proportion hazard regression model, an age >= 85 years (p < 0.001) and residual MR >1+ (p < 0.048) were predictors of an adverse prognosis at follow-up. In conclusion, a reduced left ventricular end-diastolic volume and improved hemodynamics occurred early after MitraClip therapy. An advanced age (>= 85 years) and residual MR >1+ were associated with an increased risk of mortality and heart failure. (C) 2019 Elsevier Inc. All rights reserved.