Salvage MitraClip in severe secondary mitral regurgitation complicating acute myocardial infarction: data from a multicentre international study

Chronic secondary mitral regurgitation (SMR) is associated with a poor prognosis among patients with heart failure (HF). Although medical therapy is the mainstay of treatment for this condition,1 data obtained from largescale registries2,3 and recent randomized controlled trials suggest that transcatheter edge-to-edge mitral valve repair with the MitraClip device may improve functional capacity and quality of life.4 While the impact of MitraClip implantation on outcomes in chronic severe symptomatic ischaemic SMR has been established,5 there are sparse data regarding patients with severe acute ischaemic SMR who are often not included in registries or randomized trials. The acute onset of severe SMR often causes pulmonary congestion and forward left ventricular failure. Although most patients may clinically improve with appropriate medical therapy, some remain symptomatic and may require urgent mitral valve intervention to allow recovery. We used the national Israeli MitraClip Registry (IMCR), a multicentre retrospective registry, involving nine sites in Israel, which collects data on all patients who underwent MitraClip procedures in Israel since January 2011. Additional data were added from three non-Israeli centres: (i) University Hospital of Zurich, Zurich, Switzerland; (ii) Sunnybrook Health Sciences Centre, Toronto, Canada; and (iii) HYGEIA Hospital, Athens, Greece. Patients were included if they were treated with MitraClip due to SMR within 90 days of myocardial infarction (MI), with no evidence of structural valvular damage (ruptured cord or papillary muscle). All patients remained symptomatic despite optimal medical therapy and were evaluated by a multidisciplinary team and were deemed high risk for surgery and therefore salvage MitraClip procedure was performed to allow stabilization and recovery. We evaluated immediate, 30-day and intermediate term outcomes in these patients. The study complies with the Declaration of Helsinki, the locally appointed ethics committee has approved the research protocol, and informed consent was obtained from all subjects (or their legally authorized representatives). Results are expressed as the mean± standard deviation, or as percentages. Paired ttest was used to compare differences between groups for continuous variables and the chisquare test was used for categorical data. From January 2011 to September 2018, 558 patients were treated with MitraClip system in Israel. Eight patients (1.4%) were identified as being treated for SMR in the