Long-term survival after MitraClip® therapy in patients with severe mitral regurgitation and severe congestive heart failure: A comparison among survivals predicted by heart failure models

BackgroundThe aim of the study was to investigate mortality following transcatheter mitral valve repair with the MitraClip System (MC) (Abbott Vascular, Santa Clara, CA, USA) in patients with mitral regurgitation and moderate-to-severe symptomatic heart failure in comparison to mortality predicted by the Seattle Heart Failure Model (SHFM) and the heart failure calculator of the meta-analysis global group in chronic heart failure (MAGGIC).Methods and resultsThis retrospective study included 194 consecutive patients, who received a MC implantation between 2009 and 2013 at our institution. The observed mortality was compared with that predicted by the SHFM and the MAGGIC after 1 year: 24% observed, 18% by SHFM (p = 0.185) and 20.9% by MAGGIC (p = 0.542). At 2 years: 32% observed vs. 33% by SHFM (p = 0.919). The subgroup of patients with end-stage heart failure and N-terminal pro-B-type natriuretic peptide (NTproBNP) >10,000 pg/ml (n = 41) had significantly worse mortality after 1 year (49%) than predicted by SHFM (24%, p = 0.034) and MAGGIC (24.8%, p = 0.041).ConclusionIn the overall patient cohort defined by 3+ to 4+ mitral valve regurgitation with New York Heart Association III and IV symptomatic heart failure, mortality following MC is consistent with that predicted by SHFM and MAGGIC for patients that are not at high risk. However, the subset of patients with severe heart failure defined by NTproBNP >10,000 pg/ml had worse than predicted mortality and may not benefit from MC therapy, mainly due to a high 30-day mortality.