Five-year c linical o utcomes after p ercutaneous e dge-to-edge m itral v alve r epair: Insights from the m ulticenter GRASP-IT r egistry

Limited evidence is available on 5 -year clinical outcomes after percutaneous edge-to-edge mitral valve repair. Methods: The Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation in ITaly (GRASP-IT ) is a multicenter registry including 304 consecutive patients undergoing Mitraclip between October 2008 and October 2013 at 4 Italian centers. Primary end point (all-cause mortality) and secondary end point (all-cause mortality or heart failure [ HF ] hospitalization) were evaluated up to 5 year s and between 1 and 5 year s. Results: Cumulative incidence of the primary and secondary end points at 1, 2, 3, 4, and 5 years were 15.1%, 26.4%, 35.5%, 42.1%, and 47.3% and 29.1%, 41.7%, 49.8%, 56%, and 62.3%, respectively. Landmark analysis between 1 and 5 years showed an incidence of primary and secondary end point of 37.9% and 46.8%, respectively. Five-year event rates were significantly higher in patients with functional isch emic mitral regurgitation ( MR ) compared to other etiologies. MR recurrence and left ventricular ejection fraction <30% were associated with an increased risk of both primary and secondary end point s. EuroSCORE II >5% was associated with an increased risk of 5-year mortality. Isch emic etiology of MR, baseline serum creatinine >1.5 mg/ dL, chronic obstructive pulmonary disease, and previous HF hospitalizations were independent predictors of 5-year secondary end point. Conclusions: At 5-year follow-up after Mitraclip, nearly half of patients died and almost two third s died or were admitted for HF. MR recurrence, isch emic etiology, high comorbidity burden (i e, EuroSCORE II >5%, chronic obstructive pulmonary disease ), and advanced cardiomyopathy (i e, left ventricular ejection fraction <30%, prior HF admission, creatinine >1.5 mg/dL) significantly increase the relative risk of 5-year clinical events.