Hemodynamic Effects of Interventional Edge-to-Edge Mitral Valve Repair in Patients with End-Stage Heart Failure Awaiting Heart Transplantation

Objectives: Functional mitral regurgitation is complicating end-stage heart failure and potential heart transplantation by augmenting pulmonary artery pressures. The aim of the present study was to investigate feasibility and hemodynamic effects of interventional edge-to-edge mitral valve repair using the MitraClip device in patients with end-stage heart failure awaiting heart transplantation.

Methods: In this retrospective study, we identified 9 patients suffering from end-stage heart failure listed for heart transplantation in whom moderate-severe or severe functional mitral regurgitation was recognized and treated with interventional edge-to-edge mitral valve repair. In an as-treated analysis twenty-six patients listed for heart transplantation and presenting with moderate-severe or severe functional mitral regurgitation served as controls, 22 in the pre-MitraClip era, and 4 in the MitraClip era with failed implantation. Patients were analyzed at two separate time points: MitraClip group: pre and post procedure (follow-up: 215.2 ± 53.3days), control group: study entry with recognition of moderate-severe or severe functional mitral regurgitation or pre and post failed MitraClip attempt (follow-up: 196.6 ± 46.8 days).

Results: Endovascular mitral valve repair with the MitraClip was feasible and safe in our high-risk end-stage heart failure population. Endovascular mitral valve repair resulted in significant reduction of mitral regurgitation, left atrial diameter, pulmonary artery pressures and NYHA class and improved mixed-venous oxygen saturation. No changes in the control group were observed.

Conclusions: MitraClip implantation as “bridge-to-transplant” strategy in patients with end-stage heart failure and severe functional mitral regurgitation awaiting heart transplantation is feasible and appears to result in favorable hemodynamic effects.