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Page 2 of 9 Benito-González et al. Mini-invasive Surg 2020;4:67 I http://dx.doi.org/10.20517/2574-1225.2020.54

Conclusion: Frailty was common in patients undergoing PMVR in our institution. Despite post-procedural clinical
improvement, frailty was related to adverse outcomes in our series.

Keywords: Percutaneous mitral valve repair, mitral regurgitation, frailty

INTRODUCTION
In the last decade, percutaneous mitral valve repair (PMVR) with MitraClip® device (Abbot Vascular, Santa
Clara, USA) has proven to be an effective therapy to reduce mitral regurgitation (MR), with a low incidence
[1]
of complications in patients deemed as high-risk candidates or unfit for conventional surgery . Risk
stratification in these patients is challenging and it is usually based on non-dedicated risk scores developed
[2]
in the surgery field, with a modest predictive value in this scenario .
Frailty is a clinical syndrome related to aging and characterised by a decrease in so-called “biological
reserve” against a stressful event, which implies a situation of vulnerability in the case of intercurrent
[3]
disease or medical issues requiring hospitalization . Current candidates for PMVR are characterized by
[4,5]
advanced age and a high prevalence of cardiovascular and non-cardiovascular comorbidities . All these
factors have been commonly related to frailty. The main objective of our study was to assess the prevalence
of frailty in a cohort of patients undergoing PMVR, and to assess its impact on clinical outcomes during
follow-up.

METHODS
Study population
A prospective registry was performed including of all consecutive patients with symptomatic MR grade
3+ or 4+ who underwent elective PMVR in our center between June 2014 and March 2018. Those who
received a MitraClip® as an urgent procedure (n = 15), during an admission for decompensated heart failure
(HF), were excluded from the analysis.

Study procedures
The indications for PMVR in each patient were discussed by an interdisciplinary Heart Team, including
clinical and interventional cardiologists, cardiac surgeons, and imaging specialists. Pre-procedural
transthoracic and transesophageal echocardiography was performed in all patients to assess the severity
of MR and the anatomical suitability for clip implantation, following current recommendations from the
European Association of Cardiovascular Imaging for valvular heart disease assessment . PMVR was
[6]
carried out under general anesthesia with guidance of fluoroscopy and transesophageal echocardiography.

[7]
Frailty was assessed according to functional FRAIL scale at admission for elective PMVR . The FRAIL
questionnaire includes 5 components (Fatigue, Resistance, Ambulation, Illness and Loss of weight)
and scores range from 0 to 5, considering as frail patients with score of 3-5. Baseline characteristics,
echocardiographic and biochemical findings were collected. Procedural and 30-day clinical and
echocardiographic outcomes were collected. New York Heart Association (NYHA) functional class was
documented at the 6-month scheduled outpatient clinic after discharge. Long-term clinical follow-up was
performed including primary re-admission for heart failure (HF) and death from any cause.

Study outcomes
Procedural results and adverse outcomes during follow-up were defined according to the “Mitral Valve
[8]
Academic Research Consortium” . Technical success was defined as the implantation of at least 1 clip in
the absence of procedural mortality or the need for emergency cardiovascular surgery. Device success at