422 Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

The MitraClip procedure is established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, we aimed to evaluate five-year outcomes after MitraClip. 265 patients (Age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60,5% secondary MR: sMR) undergoing MitraClip were included. Despite procedural success of 91.3%, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04). Five years after MitraClip, the majority of patients presented with reduced symptoms, sustained MR reduction (≤ grade 2) and improved functional capacity (Functional NYHA class: p = 0.0001; six minutes walking test: p = 0.04) and right ventricular (RV) function. Systolic pulmonary artery pressure (sPAP) was significantly reduced during FU only in sMR patients, (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, five-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality. MitraClip showed low complication rates and sustained MR reduction with improved RV function and sPAP five years after the procedure, which was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher five-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and five-year mortality.