Interventional Treatment of Mitral Insufficiency With Edge-to-Edge Valvuloplasty in Terms of Etiologic Factor: Immediate Results

Aim        To study the immediate outcome of an interventional method for the treatment of mitral regurgitation (MR) using the MitraClip system (Abbott Vascular) in the context of the etiological factor.

Material and methods         

This was a prospective, single-center study. A total of 89 patients treated in 2023-2024 were included in the analysis. Most patients belonged to an older age group (67.6 ± 9.3 years) where males predominated (57.3%). Echocardiography (EchoCG) was performed on a Philips EPIQ CVx ultrasound system using X5-1 and X8 t transducers. The severity of MR was assessed by multiparametric EchoCG. Quantitative measurements were performed in accordance with current Guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE and EACVI, 2015).

Results    In 19.1% of cases, the cause of MR was mitral valve leaflet chordae prolapse or rupture (primary mitral regurgitation (PMR) group, group 1). In 80.9% of cases, MR was secondary: in 29.2%, MR was atrial functional mitral regurgitation (a-FMR, group 2) and in 51.7%, MR was ventricular FMR (v-FMR, group 3). Comparative analysis of EchoCG data showed that with a comparable MR degree, the left ventricular systolic function was significantly lower in the v-FMR group than in the PMR group, and was also inferior to that in the a-FMR group (42.7±10.2% vs. 53.5±8.5 and 49.2±10.7%, respectively; p_1-3<0.001, p_2-3=0.029). The effectiveness of the procedure evident in a reduction of the MR degree was achieved in 93.2% of patients (grade <1 in 64% of them). The maximum reduction in MR to grade I and less was noted in the v-FMR group (71.7%); this proportion was higher compared to other groups (a-FMR, 57.7%; PMR, 52.9%). All groups had improvements in symptoms and in the NYHA chronic heart failure (CHF) functional class (FC). The v-FMR group achieved a more pronounced symptomatic improvement and a reduction in FC (95.7% of patients with FC II).

Conclusion            Transcatheter edge-to-edge mitral valve reconstructive procedures using the MitraClip system achieved significant immediate reductions in MR, regardless of its etiology. Long-term follow-up is essential to assess the result sustainability.

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