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Effects of levosimendan in patients with severe functional mitral regurgitation undergoing MitraClip implantation

Giannini, Cristinaa; Petronio, Anna S.a; Fiorelli, Francescaa; Liga, Riccardoa; Spontoni, Paoloa; De Carlo, Marcoa; Marraccini, Emiliaa; Pieroni, Andreaa; Guarracino, Fabiob

Journal of Cardiovascular Medicine: September 2017 - Volume 18 - Issue 9 - p 679–686
doi: 10.2459/JCM.0000000000000537
Research articles: Mitral valve disease

Aim Percutaneous mitral valve repair (PMVR) with a MitraClip device has been recently introduced as a valuable therapy in high surgical risk patients with functional mitral regurgitation (FMR) who are not responding to currently available medical treatments. Our aim was to assess the clinical, functional and prognostic impact of periprocedural levosimendan administration in patients with end-stage heart failure and FMR undergoing PMVR.

Methods Between December 2009 and August 2016, 94 consecutive high-risk patients with symptomatic FMR who underwent PMVR with the MitraClip System at our center were enrolled in a prospective registry. To identify two comparable groups of patients, 27 patients receiving levosimendan (No-L-group) were selected for the analysis matching by propensity score with those not treated with levosimendan (L-group).

Results Baseline demographics and echocardiographic variables were similar between the two groups. Acute procedural success was similarly high in both groups with no significant differences in procedural time and hospital outcomes. At discharge, echocardiographic parameters did not differ among groups except for higher value of right ventricle tissue Doppler imaging peak systolic-wave velocity in the L-group (10.7 versus 13.0 cm/s, P = 0.03, respectively). There was no significant difference in 1-year mortality between patients receiving levosimendan and those not treated with levosimendan.

Conclusion Prophylactic levosimendan did not affect long-term outcome in patients undergoing PMVR. However, levosimendan as an adjunctive therapy to MitraClip implantation offers further therapeutic advantages in patients with advanced heart failure by improving systolic right ventricle function.

aCardiac Thoracic and Vascular Department

bDepartment of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy

Correspondence to Cristina Giannini, MD, PhD, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy E-mail:

Received 20 March, 2017

Revised 29 May, 2017

Accepted 1 June, 2017

© 2017 Italian Federation of Cardiology. All rights reserved.