Abstract 3789: Reverse Remodeling of the Left Ventricle after Percutaneous Mitral Valve Repair Using the Evalve MitraClip Device
Background: Reduction in LV volume occurs after surgical mitral valve (MV) repair for mitral regurgitation (MR). The relationship between reverse remodeling and degree of residual MR after MV repair is not well known. The EVEREST study evaluates a percutaneous approach to reduce MR with a clip (MitraClip, Evalve Inc.).
Methods: 55 pts with moderate-severe or severe MR (3+ or 4+) with symptoms (or asymptomatic with LVESD >45 mm or EF less than 60%), an EF>30% and a LVESD<55 mm were enrolled. Echocardiography performed at baseline and six months was analyzed by a core lab to quantify LV volumes and MR severity. Pts were divided in 3 groups based on degree of residual MR after the percutaneous procedure: MR 1+ (Group A); MR 2+ (Group B); and MR 3+ or 4+ (Group C). Group C pts had residual MR of 3+ or 4+ after the percutaneous procedure and includes pts without a MitraClip implant.
Results: Mean age was 68.2±13.8 years. Mean RV reduced from 49.8 ml (±21.0) at baseline to 19.9 ml (±13.7) at six months (P,0.00001) for groups A and B combined. While Group C did not have MR ≤ 2+, a 20% reduction in RV was still achieved. At baseline, the groups had comparable LVEDV without significant differences between groups. At six months, Group A+B combined had a significant reduction in LVEDV (p<0.02) compared to baseline. Reduction in LVEDV in Group A alone (p=0.0861) and Group B (p=0.1118) alone approached but did not reach significance due to small sample size. Comparison of Group A and B at six months shows no significant difference in LVEDV (p=0.92). Both Groups A and B had a significant decrease in LVEDV (p<0.02) compared to Group C. Although not statistically significant, LVESV in group A and B decreased to a similar extent compared to baseline, whereas LVESV in group C did not decrease.
Conclusions: In patients with 3+ or 4+ MR at baseline, percutaneous MV repair with the MitraClip is effective in reducing the severity of MR. The reduction in MR results in reverse remodeling at 6 months both for pts with 1+ or 2+ residual MR.