MitraClip for radiotherapy-related mitral valve regurgitation

Objective: Owing to mediastinal and cardiac damage burden, the surgical treatment of radiotherapy-related mitral regurgitation (MR) may be associated with high operative risk or might even contraindicated. We evaluated the feasibility and outcome of MitraClip therapy in patients with radiotherapy-related MR as an alternative to surgery. Methods: Based on Doppler Echocardiography, 15 of 33 screened patients underwent MitraClip implantation. Results: Following MitraClip MR improved (residual MR <= 2+) without significant mitral valve stenosis (planimetric area 2.83 +/- 0.8 cm(2), mean gradient 4.6 +/- 1.8 mm Hg). All patients completed a 6-month follow-up, while 14 of 15 patients achieved a longer follow-up, ranging from 12 to 72 months (median 24 months, IQR 42 months). At 6-month follow-up we observed NYHA improvement in 13 patients with an increase of 6-min walking covered distance (from 260 +/- 34 to 367 +/- 70, p < 0.001), sustained moderate or less MR, mild mitral stenosis in 3 patients, and significant systolic Pulmonary Artery Pressure (PAPs) reduction (from 52.5 +/- 14 to 42 +/- 9, p < 0.01). Sustained clinical improvement and <= 2+ MR was observed in 13 of 14 patients who completed the 12-month follow-up. Two patients died of acute pneumonia (11 months and 60 months, respectively). One patient developed moderate MV stenosis (MVA 1.4 cm(2)) at last follow-up (48 months) without related clinical instability. Tricuspid regurgitation improved in 12 patients with further improvement at late follow-up in 2 of 3 patient with 3+. Conclusion: MitraClip may be an effective treatment for RT-induced MR, although unexpected late stenosis may occur in the context of sustained reactive mitral apparatus damage following mediastinal radiation. (C) 2018 Hellenic Society of Cardiology. Publishing services by Elsevier B.V.