Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

• Main Authors: Dan Haberman, Rodrigo Estévez-Loureiro, Tomas Benito-Gonzalez, Paolo Denti, Dabit Arzamendi, Marianna Adamo, Xavier Freixa, Luis Nombela-Franco, Pedro Villablanca, Lian Krivoshei, Neil Fam, Konstantinos Spargias, Andrew Czarnecki, Isaac Pascual, Fabien Praz, Doron Sudarsky, Arthur Kerner, Vlasis Ninios, Marco Gennari, Ronen Beeri, Leor Perl, Haim Danenberg, Lion Poles, Sara Shimoni, Sorel Goland, Berenice Caneiro-Queija, Salvatore Scianna, Igal Moaraf, Davide Schiavi, Claudia Scardino, Noé Corpataux, Julio Echarte-Morales, Michael Chrissoheris, Estefanía Fernández-Peregrina, Mattia Di Pasquale, Ander Regueiro, Carlos Vergara-Uzcategui, Andres Iñiguez-Romo, Felipe Fernández-Vázquez, Danny Dvir, Maurizio Taramasso, Mony Shuvy
• Format: Article
• Language: English
• Published: MDPI AG 2021-04-01
• Series: Journal of Clinical Medicine
• Subjects: mitral regurgitation; percutaneous mitral valve repair; acute myocardial infarction; left ventricle dysfunction
• Online Access: https://www.mdpi.com/2077-0383/10/9/1819

Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)—35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF < 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, <i>p</i> = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, <i>p</i> = 0.51 and 19% vs. 12%, <i>p</i> = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded.