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A-FMR is considered a specific sub-type of secondary MR in patients with atrial fibrillation (AF) and preserved left ventricle ejection fraction (LVEF). Aim of the study was to investigate the acute and mid-term outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) with the MitraClip in atrial functional mitral regurgitation (A-FMR). The study included patients with A-FMR and concomitant AF who underwent to the MitraClip at 7 Italian Centers. Aim of the study was to assess the safety, efficacy and mid-term cardiovascular outcomes. After reviewing 1153 patients with FMR treated with TMVr from 2009 to 2021, 87 patients (median age 81 years, 61% female) with A-FMR were identified. Technical success was achieved in 97%, 30-day device success in 83% and 30-day procedural success in 80%. All-cause death at 30-day was 5%. Estimated two-year freedom from all-cause death and cardiac death was 60% and 77%, respectively, whereas freedom from all-cause death/heart failure hospitalization was 55%. Residual MR ≤ 2+ was encountered in 89% (n = 47/53) and improvement in NYHA class I/II in 79% (n = 48/61). Post-procedural MR ≥ 2+ (HR 5.400, CI 1.371–21.268) and inter-commissural annular diameter ≥ 35 mm (HR 4.159, CI 1.057–16.363) were independent predictors of all-cause death/heart failure hospitalization during the follow-up. Positive reverse remodeling of left atrium and mitral annular dimensions occurred after TMVr during the follow-up. MitraClip resulted to be a safe and effective option to treat A-FMR in elderly patients. The MITRA-TUNE registry: A-FMR characteristics and changes in MR and NYHA class during the follow-up after MitraClip (A) Compared to baseline (34.5% MR 3+ and 65.5% MR 4+), a statistically significant improvement was observed at discharge (70% MR 1+, 28% MR 2+, 2% MR ≥3+, p ≤ 0.001) and at the follow-up (43% MR 1+, 46% MR 2+, 11% MR 3+, p ≤ 0.001). Median echocardiographic follow-up was 371 days [IQR 158–1067 days]. (B) Compared to baseline (17% NYHA II, 71% NYHA III and 12% NYHA IV), a statistically significant improvement was observed at the follow-up (4% NYHA I, 75% NYHA II, 18% NYHA III, 3% NYHA IV, p ≤ 0.001). Median clinical follow-up was 489 days [IQR 242–1033 days]. LVEF = left ventricle ejection fraction; LVEDD = left ventricle end-diastolic diameter; LV = left ventricle; MR = mitral regurgitation; FMR = functional mitral regurgitation; TMVr = transcatheter mitral valve repair; A-FMR = atrial functional mitral regurgitation; MVARC = Mitral Valve Academic Research Consortium; NYHA = New York Heart Association. [Display omitted] • Up to 1135 patients with FMR treated in Italy with the MitraClip, 87 (7.6%) fulfilled criteria for A-FMR • The MitraClip in A-FMR presented a technical success of 97%, 30-day device success of 83% and procedural success of 80%. • Estimated two-year freedom from all-cause death and cardiac death was 60% and 77%. • Positive reverse remodeling of LA and mitral annular dimensions occurred after the MitraClip during the follow-up. [ABSTRACT FROM AUTHOR]

Aims: In patients with heart failure and reduced ejection fraction (HFrEF) and secondary mitral regurgitation (SMR), impaired right ventricular function (RVF) may negatively influence the prognosis. Percutaneous mitral valve repair (pMVR) can promote the recovery of RVF. We sought to characterize the response of the right ventricle to pMVR in HFrEF with SMR and to assess the association between improved RVF after pMVR and outcomes.Methods and Results: Overall, 221 patients with HFrEF and SMR ≥3+ successfully treated with pMVR in four tertiary care centres for heart failure were included. Improved RVF was defined as Δ right ventricular fractional area change (ΔRVFAC) ≥5% at early follow-up (median time 4 months). The primary endpoint was a composite of death/heart transplantation (D/HT). Mean age was 69 ± 11 years, mean left ventricular ejection fraction was 31 ± 8% and mean RVFAC was 34 ± 9%. ΔRVFAC ≥5% occurred in 88 patients (40%) and was independent of the measures of left ventricular reverse remodelling. During a median follow-up of 29 months (interquartile range 12-46), 81 patients (37%) reached the primary endpoint. After adjustment for other significant covariates, ΔRVFAC ≥5% was significantly associated with lower risk of D/HT (hazard ratio 0.52, 95% confidence interval 0.29-0.94, P = 0.030). In the secondary outcome analysis exploring the risk of heart failure hospitalizations, ΔRVFAC ≥5% confirmed the prognostic association with the endpoint.Conclusions: In patients with HFrEF and SMR, about 40% of patients improved RVF after pMVR. RVF improvement was associated with better long-term survival free from HT and lower risk of heart failure hospitalization. [ABSTRACT FROM AUTHOR]

Percutaneous mitral valve repair (PMVR) with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) is a valid therapeutic option for patients with severe mitral regurgitation (MR) deemed to be at high or prohibitive surgical risk. Despite the reassuring data on efficacy and long-term durabil- ity of the procedure, the proportion of patients with residual or relapsing severe MR after MitraClip therapy is not negligible. In light of the detrimental prognostic impact of severe MR, repeat interventions are increasingly performed in clinical practice using different techniques. In high-risk settings, percutaneous procedures have proven to be effective and safe at reducing MR. Building on this, we sought to summarize the current landscape and clinical experience of reinterventions after failed MitraClip therapy, so as to assist physicians facing the clinical hurdle of proper treatment management after failed PMVR. [ABSTRACT FROM AUTHOR]

We present a case of a patient with severe mitral regurgitation referred to our Institution for an echocardiographic examination as part of the routine workup to assess the eligibility for mitral valve percutaneous repair with either the MitraClip or Cardioband systems. Echocardiography showed the presence of an unusual interatrial membrane in the left atrium that represented a contraindication for the puncture of the interatrial septum. The patient was finally deferred to percutaneous mitral valve replacement using transapical access. [ABSTRACT FROM AUTHOR]