High risk patients with degenerative mitral regurgitation who are contraindicated for surgery may now benefit from minimally invasive techniques. We aimed to evaluate the efficiency and safety of 2recent techniques: Mitraclip, an edge-to-edge suture by endovascular access, and Neochord, a transpical implantation of artificial chordae tendinae.

Patients with severe mitral degenerative regurgitation were included at the University Hospital of Montpellier, with clinical and echocardiographic follow-up performed at baseline and at 6months. The primary endpoint of the study evaluated success of the procedure (defined as residual MR grade ≤2) and evolution of the NYHA functional class. Secondary endpoints included several echocardiographic parameters.

Between January 2016 and October 2018, 26patients were evaluated, 22 of them in the Mitraclip group and 4 in the NeoChord group. In the Mitraclip group, the procedure was successful in 15/22 patients (69%), with one death and one implantation failure observed. An improvement of NYHA functional class occurred in all patients with successful procedure. We observed a decrease of the left ventricular end-diastolic volume from 110 to 103mL (P=0.005), and of the left ventricular end-diastolic diameter from 55 to 50mm (P=0.001). The peak pressure gradient between the right ventricle and right atrium decreased from 59 to 40mmHg (P=0.002). Conversely, there was no improvement of primary endpoint in the NeoChord group, with even a worsening of the NYHA stage and the MR severity for 3/4 patients.

In the Mitraclip group, MR severity was significantly reduced in 69% of patients, leading to functional improvement when successful. The NeoChord technique seems quite disappointing, but is still to be evaluated in the long term on a larger scale. The Mitraclip is an alternative for high-risk patients contraindicated for surgery, with an acceptable success rate in this study.