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Severe mitral regurgitation recurrence after successful percutaneous mitral edge-to-edge repair by Mitraclip: Insights from a three-dimensional echocardiography study
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  • Yoan Lavie Badie,
  • Fabien Vannier,
  • Eve Cariou,
  • Pauline Fournier,
  • Romain Itier,
  • Stéphanie Cazalbou,
  • Virginie Blanchard,
  • Michel Galinier,
  • Didier Carrie,
  • Olivier Lairez,
  • Frédéric Bouisset,
  • Thibault Lhermusier
Yoan Lavie Badie
Hopital de Rangueil
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Fabien Vannier
Hopital de Rangueil
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Eve Cariou
Hopital de Rangueil
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Pauline Fournier
Hopital de Rangueil
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Romain Itier
Hopital de Rangueil
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Stéphanie Cazalbou
Hopital de Rangueil
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Virginie Blanchard
Hopital de Rangueil
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Michel Galinier
Hopital de Rangueil
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Didier Carrie
Hopital de Rangueil
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Olivier Lairez
Hopital de Rangueil
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Frédéric Bouisset
Hopital de Rangueil
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Thibault Lhermusier
Hopital de Rangueil
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Abstract

Background: The sustainability of the results of mitraclip procedures is a source of concern. Aims: To investigate risk factors of severe mitral regurgitation (MR) recurrence after Mitraclip in primary MR. Methods and results: Eighty-three patients undergoing successful Mitraclip procedures were retrospectively included. Valve anatomy and Mitraclips placement were comprehensively analyzed by post-processing 3D echocardiographic acquisition. The primary composite endpoint was the recurrence of severe MR. Mean age was 83±7 years-old, 37 (44%) were female. Median follow-up was 381 days (IQR 195-717) and 17 (20%) patients reached the primary endpoint. Main causes of recurrence of severe MR were relapse of a prolapse (64%) and single leaflet detachment (23%). Posterior coaptation line length (HR 1.06 95%CI 1.01-1.12 p=0.02), poor imaging quality (HR 3.84, 95%CI1.12-13.19; p=0.03), and inter-clip distance (HR 1.60, 95%CI 1.27-2.02; p<0.01) were associated with the occurrence of the primary endpoint. Conclusions: Recurrence of severe MR after a MitraClip procedure for primary MR is common and results from a complex interplay between anatomical (tissue excess) and procedural criteria (quality of ultrasound guidance and MitraClips spacing).

Peer review status:ACCEPTED

22 Jan 2021Submitted to Echocardiography
23 Jan 2021Submission Checks Completed
23 Jan 2021Assigned to Editor
27 Jan 2021Reviewer(s) Assigned
07 Mar 2021Review(s) Completed, Editorial Evaluation Pending
12 Mar 2021Editorial Decision: Revise Major
24 Mar 20211st Revision Received
25 Mar 2021Assigned to Editor
25 Mar 2021Submission Checks Completed
29 Mar 2021Reviewer(s) Assigned
04 May 2021Review(s) Completed, Editorial Evaluation Pending
05 May 2021Editorial Decision: Revise Major
08 Jun 20212nd Revision Received
09 Jun 2021Submission Checks Completed
09 Jun 2021Assigned to Editor
14 Jun 2021Reviewer(s) Assigned
06 Jul 2021Review(s) Completed, Editorial Evaluation Pending
06 Jul 2021Editorial Decision: Accept