Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO): impact of valve disease aetiology and residual mitral regurgitation after MitraClip implantation

Abstract

Aims The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) was conceived in order to assess the safety and efficacy of MitraClip therapy in Italy. The aim of this study was to assess procedural and mid‐term outcomes, and clinical and echocardiographic predictors of mid‐term mortality after MitraClip therapy, stratifying the results according to the diagnosis of functional and degenerative mitral regurgitation (FMR vs. DMR). Methods and results Between January 2016 and March 2020, 1659 patients were prospectively included in the GIOTTO registry (FMR 59.4% vs. DMR 40.6%). Acute Mitral Valve Academic Research Consortium (MVARC) technical success was achieved in 97.2% of patients, without differences between FMR and DMR and with sustained results at 30 days. In the study population, all‐cause mortality was 4.0%, 17.5% and 34.6% at 30 days, 1 year and 2 years, respectively. Cardiovascular death was the most frequent cause of mortality. Overall hospitalization rates were 6.3%, 23.4% and 31.7% at 30 days, 1 year and 2 years, respectively. The most frequent cause of hospitalization was heart failure, particularly in the first 30 days. FMR and MVARC structural and functional failure were strongly associated with 1‐year mortality. Residual mitral regurgitation 1+ (rMR) was independently related to a reduced risk of 1‐year mortality (hazard ratio 0.62; P = 0.005). Coherently, at 2‐year follow up, FMR was associated with worse outcomes than DMR, and Kaplan–Meier all‐cause mortality was related to rMR. Conclusions Functional mitral regurgitation aetiology affects 1‐year mortality after MitraClip implantation, and differences in mortality and hospitalization rates between FMR and DMR can be observed within 2 years. Optimal rMR 1+ was correlated to a more favourable mid‐term outcome, particularly in FMR.

Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XTR by three‐dimensional echocardiography

“…Notably, the DMR group had a high prevalence of leaflet flail or multiple prolapse cases, usually judged as sub-optimal for percutaneous approach with older device versions. Nevertheless the early experience, MitraClip XTR implantation demonstrated an optimal technical success rate even in these challenging cases, 24 , 25 with acute outcomes comparable between FMR and DMR cohorts 26 and resembling recent literature data on MitraClip performance. 2 , 12 At baseline, FMR patients showed a greater angulation of both anterior and posterior leaflets, confirming leaflet displacement as the main determinant of valve regurgitation, 27 while degenerative affec-tion (Fibroelastic deficiency and Barlow's disease) mainly produced an exaggeration of physiologic annular excursion during the cardiac cycle.…”

Severe mitral regurgitation recurrence after successful percutaneous mitral edge‐to‐edge repair by Mitraclip in primary mitral regurgitation: Insights from a three‐dimensional echocardiography study

“…This is a known complication, as it has been observed in 9% of the patients in the EVEREST I study 6 . However, our rate of clip detachments appears to be higher (4.8%) than other registries, like the .7% in the recent GIOTTO 19 . From an anatomical point of view, partial clip detachment occurs when the load applied to the clipped parts of both leaflets and the MitraClip overcome the tissue resilience.…”

“…6 However, our rate of clip detachments appears to be higher (4.8%) than other reg-istries, like the .7% in the recent GIOTTO. 19 From an anatomical point of view, partial clip detachment occurs when the load applied to the clipped parts of both leaflets and the MitraClip overcome the tissue resilience. Indeed, tension over the Mitraclip becomes maximum in the diastolic phase.…”

Transcatheter mitral valve repair for primary and secondary mitral regurgitation: new insights from a nationwide registry

“…Indeed, previous European registries have shown a predominance of secondary MR in patients treated with TMVr. The analysis of the GIOTTO registry published in this issue of the Journal confirms this observation with 59% of patients presenting with secondary MR 10 . This finding is probably the consequence of the selection of high‐risk patients for TMVr and illustrates the reluctance of practitioners to consider mitral valve surgery in patients with secondary MR in whom there is no strong evidence that the clinical benefits outweigh the operative risk.…”