Abstract 1698: Significant Reverse Remodeling of the Left Ventricle One Year After Percutaneous Mitral Repair with the MitraClip™ Device in Patients with Pre-existing Systolic LV Dysfunction.
Background: Percutaneous mitral repair in patients with systolic left ventricular (LV) dysfunction has not been previously evaluated. We report significant LV reverse remodeling, i.e. reversal of chamber changes following successful repair with the MitraClip device (Evalve, Inc. Menlo Park, CA) in patients with moderate to severe or severe MR and pre-existing LV dysfunction.
Methods: LV dysfunction was defined as LV end systolic dimension (LVID-s) > 4.5cm and/or EF < 55%. American Society of Echocardiography criteria were used for systematic core laboratory assessment of MR and LV function. Transthoracic echocardiography was performed at baseline and 12 months
Results: Eighteen EVEREST registry patients with significant MR and LV dysfunction underwent successful repair with the MitraClip and were discharged from the hospital with MR severity ≤ 2+. Matched data at baseline and 12 months is available for 14 patients who continue surgery free at 12 months. Mean age was 71 ± 12 years. Mean LVID-s and EF were 4.4 ± 0.5 cm and 47 ± 8% at baseline. Matched pair analyses comparing baseline to 12 months show a significant reduction in mean: MR grade (2.8 to 1.5, p < 0.0001), LV end systolic volume (LVESV: 109 to 87 ml, p < 0.004), LV end diastolic volume (LVEDV: 207 to 171 ml, p < 0.003), LVID-s (4.4 to 3.9 cm, p < 0.003) and LV end diastolic dimension (LVID-d: 5.9 to 5.4 cm, p < 0.014). Twelve of 14 (86%) patients experienced reverse LV remodeling. While there was no significant change in LV ejection fraction for the group, (p < 0.10) analysis showed a trend toward increased EF, with an increase in 11 of 14 (79%) patients. NYHA Functional Class also improved in this patient population from baseline to 12 months (2.8 to 1.4, p < 0.0006).
Conclusions: EVEREST registry data suggest that patients with 3+ or 4+ MR and pre-existing systolic LV dysfunction who undergo successful repair with the MitraClip experience significant reverse LV remodeling and corresponding clinical improvement.