• Daniel Kalbacher, Ulrich Schäfer, R Stephan V Bardeleben, Holger Eggebrecht, Horst Sievert, Georg Nickenig, Christian Butter, Andreas E May, Raffi Bekeredjian, Taoufik Ouarrak, Karl-Heinz Kuck, Björn Plicht, Ralf Zahn, Stephan Baldus, Hüseyin Ince, Wolfgang Schillinger, Peter Boekstegers, Jochen Senges, and Edith Lubos.
• Universitäres Herzzentrum Hamburg Eppendorf, Germany. Electronic address: d.kalbacher@uke.de.
• Int. J. Cardiol. 2019 Feb 15; 277: 35-41.

BackgroundMitraClip therapy is increasingly used in patients deemed inoperable to treat severe mitral regurgitation (MR), but long-tern data is scarce.AimsThe multicentre, industry-independent German Transcatheter Mitral Valve Interventions (TRAMI) registry comprises the largest prospectively enrolled cohort of patients treated by MitraClip therapy. The current analysis is focusing on long-term mortality rates, cardiac rehospitalization and reintervention.Methods And ResultsLong-term follow-up (median time 1037 days) in the TRAMI registry was available for 722 patients treated at 20 German centres. Improvements in New York Heart Association (NYHA) functional class (I/II long-term: 65% vs. 1-year follow-up: 63.3%) and self-rated health-status (EuroQuol visual analogue scale [EQ VAS] long-term: 60 [50-70] vs. 1-year follow-up: 60 [50; 70]) were pertained over time. Estimated mortality rates by Kaplan-Meier method were 19.7% for 1-year, 31.9% for 2-year and 53.1% for 4-year follow-up without differences found for MR aetiology. Multivariable Cox-regression analysis identified previous aortic valve implantation (hazard ratio [HR] = 2.21; p < 0.0001), NYHA class IV (HR = 1.78; p < 0.001), prior cardiac decompensation (HR = 1.63; p < 0.001), creatinine > 1.5 mg/dl (HR = 1.63; p < 0.0001) and left ventricular ejection fraction < 30% (HR = 1.60; p < 0.001) as most predictive for long-term mortality.ConclusionsLong-term outcome in the TRAMI registry confirmed lasting clinical improvements and low intervention rates. Long-term mortality was strongly influenced by cardiac and non-cardiac co-morbidities and was found comparable for both MR aetiologies.Copyright © 2018 Elsevier B.V. All rights reserved.

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