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J Am Coll Cardiol. 2013 Dec 24;62(25):2370-2377. doi: 10.1016/j.jacc.2013.05.093. Epub 2013 Sep 4.

Echocardiographic and clinical outcomes of central versus noncentral percutaneous edge-to-edge repair of degenerative mitral regurgitation.

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National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
Division of Cardiology, Rigshospitalet, Copenhagen, Denmark. Electronic address:
Unit for Interventional Cardiology, Department of Cardiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.



This study aimed to assess the clinical and echocardiographic results of MitraClip implantation in noncentral degenerative mitral regurgitation (dMR) compared with central dMR.


It is unknown whether the use of MitraClip therapy in noncentral dMR is as safe and effective as in central dMR.


We analyzed a multicenter registry of 173 patients treated with the MitraClip and compared results of central and noncentral dMR.


Seventy-nine patients (age 79.2 ± 8.0 years, 58.2% men) had dMR. Forty-nine patients (62%) had central dMR, with the remainder classified as noncentral dMR (n = 30, 38%). Patients with noncentral dMR had a wider pre-procedural vena contracta (8.5 ± 2.0 mm vs. 6.9 ± 2.2 mm, p = 0.039) and higher systolic pulmonary pressure (57.9 ± 18.0 vs. 47.3 ± 13.0 mm Hg, p = 0.019). Procedural success was the same in both groups (95.5% central vs. 96.7% noncentral, p = 0.866). Post-procedural MR and New York Heart Association (NYHA) functional class at 1 month (MR ≤2, 96.0% vs. 96.6%, p = 0.866, and NYHA functional class ≤II, 81.6% vs. 90.0%, p = 0.335) and 6 months (95.2% central vs. 91.7% noncentral, p = 0.679; and NYHA functional class >II, 21.1% vs. 0%, p = 0.128) did not differ between groups. There were also no differences in serious post-procedural adverse events: partial clip detachment (central n = 1 [2.0%] vs. noncentral n = 1 [3.3%], p = 1.000), death (5.4% central vs. 13.0% noncentral, p = 0.298), or heart failure admission (10.8% central vs. 8.7% noncentral, p = 0.791).


In experienced centers, MitraClip treatment can be performed safely and effectively in both central and noncentral dMR.


2-dimensional; 2D; 3-dimensional; 3D; LV; MR; MV; NYHA; New York Heart Association; TEE; catheter-based-therapy; dMR; degenerative mitral regurgitation; heart valves; left ventricular; mitral regurgitation; mitral valve; transesophageal echocardiography

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