الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Transcatheter percutaneous mitral valve repair (TMVR) using MitraClip® became a well-established interventional therapy for patients with severe mitral regurgitation (MR). The basic concept of transcatheter edge-to-edge mitral valve repair sprouted from the Alfieri stitch double orifice technique to improve coaptation by approximation of both leaflets. EVERST II concluded that TMVR showed equivalent clinical outcomes and superior safety in comparison to surgical MVR. This research work aimed at evaluating clinical and echocardiographic outcomes of 110 patients with severe mitral regurgitation managed by TMVR via mitral clip device owing to their high surgical risk over a period of 3 years starting from 2018 till 2020 with 2 years average follow up period post procedure.
Procedural success was achieved in 101 patients with success ratio of 92%. 68 patients received a single mitral clip and 41 patients received two mitral clips in order to achieve acute procedural success. Procedure success was maintained during 2 years follow up period. Statistical comparison of NYHA functional class before and after procedure shows statistically significant improvement of NYHA functional class which was maintained during 2 years period of follow up. Mitral clip procedure is always responsible for reduction of mitral valve area and subsequently increase in transmitral mean and peak pressure gradient post procedure. Two clip strategy should be considered in case of severe MR with large 3D vena contracta or with multiple regurgitation jets, provided that preinterventional mitral valve area is sufficient and mean pressure gradient across mitral valve after implantation of first mitral clip was less than 5 mmHg. Out of 110 cases, 7 patients passed away during first month after mitral clip implantation. Causes of death were cardiogenic shock in two cases, multiorgan failure in two other patients, severe advanced heart failure, pneumonia and cerebral hemorrhage were the reason of mortality in the last three patients. Over an average of 2 years follow up, mortality was also recorded in 7 patients and was attributed to severe advanced heart failure in two patients, multiorgan failure in two cases, septicemia after ruling out of infective endocarditis in one patient and the last two cases because of malignancy.
Transcatheter edge-to-edge mitral valve repair TEER for management of severe MR becomes a standard interventional procedure with high efficacy and safety especially in high risk patients for surgical mitral valve replacement. the indications for TMVR should be carefully discussed in heart team meeting, taking into consideration the clinical profile of the case, the aetiology of MR and the anatomy of the mitral valve. Benefits of MR reduction after mitral clip implantation usually compensate the hazard of mild to moderate mitral stenosis. High transmitral mean pressure gradient post-TMVR should be avoided whenever possible, however, it does not impair the benefits of MR reduction.