{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T10:04:46Z","timestamp":1793095486590,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2019,1,2]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Secondary mitral regurgitation (SMR) occurs in the absence of organic mitral valve disease and may develop as the left ventricle dilates or remodels or as a result of leaflet tethering with impaired coaptation, most commonly from apical and lateral distraction of the subvalvular apparatus, with late annular dilatation. The optimal therapy for SMR is unclear. This study sought to evaluate the 1-year adjudicated outcomes of all patients with SMR undergoing the MitraClip procedure in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) Investigational Device Exemption program, which is comprised of the randomized clinical trial, the prospective High-Risk Registry, and the REALISM Continued Access Registry (Multicenter Study of the MitraClip System).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Patients with 3+\/4+ SMR enrolled in EVEREST II were stratified by non-high surgical risk (non-HR) and high surgical risk (HR) status (defined as Society of Thoracic Surgeons risk of mortality \u226512% or predefined risk factors). Clinical, echocardiographic, and functional outcomes at 1 year were evaluated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              A total of 616 patients (482 HR, 134 non-HR; mean age, 73.3\u00b110.5 years; Society of Thoracic Surgeons risk, 10.2\u00b16.9%) with SMR underwent the MitraClip procedure. At baseline, 80.5% of patients were in New York Heart Association class III\/IV. Major adverse events at 30 days included death (3.6%), stroke (2.3%), and renal failure (1.5%). At discharge, 88.8% had MR \u22642+. At 1 year, there were 139 deaths, and the Kaplan-Meier estimate of freedom from mortality was 76.8%. The majority of surviving patients (84.7%) remained with MR \u22642+ and New York Heart Association class I\/II (83.0%). Kaplan-Meier survival at 1 year was 74.1% in HR patients and 86.4% in non-HR patients (\n              <jats:italic>P<\/jats:italic>\n              =0.0175). At 1 year, both groups achieved comparable MR reduction (MR \u22642+, 84.0% versus 87.0%) and improvement in left ventricular end-diastolic volume (\u22128.0 mL versus \u221212.7 mL), whereas New York Heart Association class I\/II was found in 80.1% versus 91.8% (\n              <jats:italic>P<\/jats:italic>\n              =0.008) of HR and non-HR patients, respectively. In HR patients, the annualized rate of heart failure hospitalizations decreased from 0.68 to 0.46 in the 12 months before to 12 months after the procedure (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Transcatheter mitral valve repair with the MitraClip in patients with secondary MR is associated with acceptable safety, reduction of MR severity, symptom improvement, and positive ventricular remodeling.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifiers: NCT00209274, NCT01940120, and NCT01931956.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.117.031733","type":"journal-article","created":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T19:00:47Z","timestamp":1546023647000},"page":"37-47","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":132,"title":["One-Year Outcomes After MitraClip for Functional Mitral Regurgitation"],"prefix":"10.1161","volume":"139","author":[{"given":"Gorav","family":"Ailawadi","sequence":"first","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery (G.A., I.L.K.), University of Virginia, Charlottesville."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Scott","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Cardiology (D.S.L.), University of Virginia, Charlottesville."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, TX (M.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Trento","sequence":"additional","affiliation":[{"name":"Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (A.T., S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saibal","family":"Kar","sequence":"additional","affiliation":[{"name":"Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (A.T., S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Grayburn","sequence":"additional","affiliation":[{"name":"Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald D.","family":"Glower","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Durham, NC (D.D.G., A.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Wang","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Durham, NC (D.D.G., A.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elyse","family":"Foster","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California, San Francisco (E.F., A.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atif","family":"Qasim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California, San Francisco (E.F., A.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil J.","family":"Weissman","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, MD (N.J.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Ellis","sequence":"additional","affiliation":[{"name":"Abbott Vascular, Santa Clara, CA (J.E., L.C., F.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Crosson","sequence":"additional","affiliation":[{"name":"Abbott Vascular, Santa Clara, CA (J.E., L.C., F.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Fan","sequence":"additional","affiliation":[{"name":"Abbott Vascular, Santa Clara, CA (J.E., L.C., F.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irving L.","family":"Kron","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery (G.A., I.L.K.), University of Virginia, Charlottesville."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Pearson","sequence":"additional","affiliation":[{"name":"Northshore University Health System, Evanston, IL (P.J.P., T.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Feldman","sequence":"additional","affiliation":[{"name":"Northshore University Health System, Evanston, IL (P.J.P., T.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the EVEREST II 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2006 guidelines for the management of patients with valvular heart disease: a Report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): developed in Collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.","volume":"114","author":"American College of Cardiology\/American Heart Association Task Force on Practice Guidelines, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons","year":"2006","unstructured":"American College of Cardiology\/American Heart Association Task Force on Practice Guidelines, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, Bonow, RO, Carabello, BA, Kanu, C, de Leon, AC, Jr, Faxon, DP, Freed, MD, Gaasch, WH, Lytle, BW, Nishimura, RA, O\u2019Gara, PT, O\u2019Rourke, RA, Otto, CM, Shah, PM, Shanewise, JS, Smith, SC, Jr., Jacobs, AK, Adams, CD, Anderson, JL, Antman, EM, Faxon, DP, Fuster, V, Halperin, JL, Hiratzka, LF, Hunt, SA, Lytle, BW, Nishimura, R, Page, RL, Riegel, B. ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease: a Report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): developed in Collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. 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