Long-Term Outcome of Patients with Severe Biventricular Heart Failure and Severe Mitral Regurgitation After Percutaneous Edge-to-Edge Mitral Valve Repair

Objective To assess long‐term outcome and parameters associated with poor and favorable outcome in patients with a left ventricular ejection fraction (LV‐EF) ≤25% and severe mitral regurgitation (MR) after percutaneous edge‐to‐edge mitral valve repair (pMVR). Background There is no data on long‐term outcome in this cohort of patients. Methods We analyzed all 34 patients with a LV‐EF ≤25% and severe MR treated with pMVR in 2 university hospitals from 2009 to 2012. Results Mitral regurgitation could be successfully reduced to grade ≤2 in 30 patients (88%). Long‐term follow‐up (up to 5 years) revealed a steep decline of the survival curve reaching 50% already 8 month after pMVR. In contrast, estimated survival of the remaining patients showed a favorable long‐term outcome. Patients deceased during the first year presented with higher right ventricular tricuspid pressure gradient (RVTG) (44.5 ± 8.4 mmHg vs. 35.2 ± 15.4 mmHg, P = 0.035) and worse RV‐function (P = 0.014) prior to the procedure. One‐year mortality of patients with pulmonary hypertension and depressed RV‐function (n = 22) was very high (77%) compared to the remaining patients (n = 12, mortality rate of 0%, P = 0.0001). Conclusions Although pMVR lead to a successful reduction of MR in patients with a LV‐EF ≤25%, 1‐year mortality in this cohort was very high. However, a subgroup of patients showed a favorable long‐term outcome after pMVR. Especially the right ventricular parameters sustained RV‐function and absence of pulmonary hypertension—easily assessed with echocardiography—might be used to identify this subgroup and encourage pMVR in these patients.