Implantation of the MitraClip has become the most frequently used percutaneous technique to treat significant (grade 3+ or 4+) mitral regurgitation (MR) in elderly patients deemed inoperable or at high surgical risk. In Europe, about two-thirds of patients treated with the MitraClip suffer from MR of functional origin secondary to ischemic or dilated cardiomyopathy. At present, there is debate among operators on whether stabilizing/supporting a single adequately implanted clip with a second clip is beneficial for patients with functional MR.
Implantation of the MitraClip has become the most frequently used percutaneous technique to treat significant (grade 3+ or 4+) mitral regurgitation (MR) in elderly patients deemed inoperable or at high surgical risk. In Europe, about two-thirds of patients treated with the MitraClip suffer from MR of functional origin secondary to ischemic or dilated cardiomyopathy. At present, there is debate among operators on whether stabilizing/supporting a single adequately implanted clip with a second clip is beneficial for patients with functional MR. Purpose To demonstrate the noninferiority of a 1-clip strategy vs. a 2-clip strategy of MitraClip implantation, when the second clip in the 2-clip study arm is implanted for stabilizing/supporting purposes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Device to approximate the mitral valve leaflets
Evaluation of number of participants who died death within one year
death
Time frame: 1 year
Evaluation of number of rehospitalizations due to heart failure among patients receiving one or two clips
heart failure rehospitalization
Time frame: 1 year
Evaluation of number of participants with recurrent regurgitation within one year
recurrence of mitral regurgitation (\>grade 2+ at 1 year)
Time frame: 1 year
death
freedom from death (1-year)
Time frame: 1 year
heart failure
freedom from heart failure (1-year)
Time frame: 1 year
rehospitalization
rehospitalization
Time frame: 1-year
regurgitation
freedom from recurrence of mitral regurgitation (\>2+; 1-year)
Time frame: 1-year
success rate
procedural success rate in 2-clip arm
Time frame: 1-year
procedure duration
procedure duration
Time frame: 1-year
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total device time
total device time
Time frame: 1-year
fluoroscopy time
fluoroscopy time
Time frame: 1-year
contrast volume
contrast volume
Time frame: 1-year
complications
periprocedural (30-day) complications
Time frame: 1-year
echocardiographic variables
The following echocardiographic variables will be assessed by 2-dimensional transthoracic echocardiography at 12 months: Left ventricular (LV) end-diastolic diameter and volume; LV end-systolic diameter and volume; LV ejection fraction; LV outflow tract diameter and velocity time integral in LV outflow tract (to calculate forward stroke volume).
Time frame: 1-year
changes in echocardiographic variables
Changes from baseline to 12 months in echocardiographically assessed (at both time points) LV end-diastolic diameter and volume; LV end-systolic diameter and volume; LV ejection fraction; and forward stroke volume.
Time frame: 1-year
NYHA
NYHA functional class
Time frame: 1-year
6-minutes walk
6-minutes walk distance
Time frame: 1-year
quality of life
Assessment of the Minnesota Living With Heart Failure Questionnaire (MLHFQ) quality-of-life score. The questionnaire consists of 21 quality-of-life questions to be answered by the patient on a grading scale of 0 (best) to 5 (worst). Thus, the overall MLHFQ score ranges from 0 to 105.
Time frame: 1-year