***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The use of transcatheter mitral valve repair ( TMVR )  has gained widespread acceptance in Europe , but data on immediate success , safety , and long-term echocardiographic follow-up in real-world patients are still limited . OBJECTIVES The aim of this multinational registry is to present a real-world overview of TMVR use in Europe . METHODS The Transcatheter Valve Treatment Sentinel Pilot Registry is a prospect i ve , independent , consecutive collection of individual patient data . RESULTS A total of 628 patients ( mean age 74.2 ± 9.7 years , 63.1 % men ) underwent TMVR between January 2011 and December 2012 in 25 centers in 8 European countries . The prevalent pathogenesis was functional mitral regurgitation ( FMR ) ( n = 452 [ 72.0 % ] ) . The majority of patients ( 85.5 % ) were highly symptomatic ( New York Heart Association functional class III or higher ) , with a high logistic EuroSCORE ( European System for Cardiac Operative Risk Evaluation ) ( 20.4 ± 16.7 % ) . Acute procedural success was high ( 95.4 % ) and similar in FMR and degenerative mitral regurgitation ( p = 0.662 ) . One clip was implanted in 61.4 % of patients . In-hospital mortality was low ( 2.9 % ) , without significant differences between groups . The estimated 1-year mortality was 15.3 % , which was similar for FMR and degenerative mitral regurgitation . The estimated 1-year rate of rehospitalization because of heart failure was 22.8 % , significantly higher in the FMR group ( 25.8 % vs. 12.0 % , p[log-rank ] = 0.009 ) . Paired echocardiographic data from the 1-year follow-up , available for 368 consecutive patients in 15 centers , showed a persistent reduction in the degree of mitral regurgitation at 1 year ( 6.0 % of patients with severe mitral regurgitation ) . CONCLUSIONS This independent , contemporary registry shows that TMVR is associated with high immediate success , low complication rates , and sustained 1-year reduction of the severity of mitral regurgitation and improvement of clinical symptoms OBJECTIVES This study was design ed to assess effects of mitral valve annuloplasty ( MVA ) on mortality in patients with mitral regurgitation ( MR ) and left ventricular ( LV ) systolic dysfunction . BACKGROUND Mitral valve annuloplasty improves hemodynamics and symptoms in these patients , but effects on long-term mortality are not well established . METHODS We retrospectively analyzed consecutive patients with significant MR and LV systolic dysfunction on echocardiography between 1995 and 2002 .  Cox regression analysis , including MVA as a time-dependent covariate and propensity scoring to adjust for differing probabilities of undergoing MVA , was used to identify predictors of death , LV assist device implantation , or United Network for Organ Sharing-1 heart transplantation . RESULTS Of 682 patients identified , 419 were deemed surgical c and i date s ; 126 underwent MVA . Propensity score derivation identified age , ejection fraction , and LV dimension to be associated with undergoing MVA . End points were reached in 120 ( 41 % ) non-MVA and 62 ( 49 % ) MVA patients . Increased risk of end point was associated with coronary artery disease ( hazard ratio [ HR ] 1.80 , 95 % confidence interval [ CI ] 1.30 to 2.49 ) , blood urea nitrogen ( HR 1.01 , 95 % CI 1.005 to 1.02 ) , cancer ( HR 2.77 , 95 % CI 1.45 to 5.30 ) , and digoxin ( HR 1.66 , 95 % CI 1.15 to 2.39 ) . Reduced risk was associated with angiotensin-converting enzyme inhibitors ( HR 0.65 , 95 % CI 0.44 to 0.95 ) , beta-blockers ( HR 0.59 , 95 % CI 0.42 to 0.83 ) , mean arterial pressure ( HR 0.98 , 95 % CI 0.97 to 0.99 ) , and serum sodium ( HR 0.93 , 95 % CI 0.90 to 0.96 ) . Mitral valve annuloplasty did not predict clinical outcome . CONCLUSIONS In this analysis , there is no clearly demonstrable mortality benefit conferred by MVA for significant MR with severe LV dysfunction . A prospect i ve r and omized control trial is warranted for further study of mortality with MVA in this population This report describes the 12-month outcomes of the a prospect i ve , multicenter , nonr and omized post-approval study of the MitraClip therapy in Europe ( ACCESS-EU postapproval study of MitraClip therapy ) with respect to preprocedural left ventricular ejection fraction ( LVEF ) . Transcatheter deployment of the MitraClip device may be considered for patients who are not suitable for conventional surgery . A total of 567 patients with significant mitral regurgitation ( MR ) underwent MitraClip therapy . Of those , 393 had functional MR ( FMR ) and were subdivided by preprocedural LVEF ( A : 10 % to 20 % , B : > 20 % to 30 % , C : > 30 % to 40 % , D : > 40 % ) . Procedural safety and efficacy and treatment outcomes including MR grade , New York Heart Association ( NYHA ) functional class , 6-minute walk test , and the Minnesota Living with Heart Failure Question naire were analyzed at baseline , 30 days , and 12 months . Baseline mean logistic EuroSCORE was 25 ± 19 ; 87 % of patients were in NYHA classes III or IV ( A : 96 % , B : 83 % , C : 90 % , D : 86 % ) . There was no incidence of death or stroke intraprocedurally . Eleven patients died within 30 days with no differences among subgroups . Kaplan-Meier survival at 12 months was 81.8 % ( A : 71 % , B : 79 % , C : 87 % , D : 86 % ) . There was a significant improvement in MR severity at 30 days and 12 months ( p < 0.0001 ) . At 12 months , all subgroups experienced similar improvements in NYHA class , 6-minute walk test , and Minnesota Living with Heart Failure Question naire . This real-world registry reports promising results of MitraClip therapy in patients with FMR . In conclusion , the low rates of hospital mortality and adverse events in patients with FMR-even in patients with severely reduced LVEF-provide additional evidence of substantial benefits after MitraClip implantation OBJECTIVES The purpose of this article is to report early and mid-term outcomes of the ACCESS-EU study ( ACCESS-Europe A Two-Phase Observational Study of the MitraClip System in Europe ) , a European prospect i ve , multicenter , nonr and omized post-approval study of MitraClip therapy ( Abbott Vascular , Inc. , Santa Clara , California ) . BACKGROUND MitraClip has been increasingly performed in Europe after approval ; the ACCESS-EU registry provides a snapshot of the real-world clinical demographic data and outcomes . METHODS A total of 567 patients with significant mitral valve regurgitation ( MR ) underwent MitraClip therapy at 14 European sites . Mean logistic European System for Cardiac Operative Risk Evaluation at baseline was 23.0 ± 18.3 ; 84.9 % patients were in New York Heart Association functional class III or IV , and 52.7 % of patients had an ejection fraction ≤40 % . RESULTS The MitraClip  implant rate was 99.6 % . A total of 19 patients ( 3.4 % ) died within 30 days after the MitraClip procedure . The Kaplan-Meier survival at 1 year was 81.8 % . Intensive care unit and hospital length of stay was 2.5 ± 6.5 days and 7.7 ± 8.2 days , respectively . Single leaflet device attachment was reported in 27 patients ( 4.8 % ) . There were no MitraClip device embolizations . Thirty-six subjects ( 6.3 % ) required mitral valve surgery within 12 months after the MitraClip implant procedure . There was improvement in the severity of MR at 12 months , compared with baseline ( p < 0.0001 ) , with 78.9 % of patients free from MR , severity of > 2 + at 12 months . At 12 months , 71.4 % of patients had New York Heart Association functional class II or class I. Six-min-walk-test improved 59.5 ± 112.4 m , and Minnesota-living-with-heart-failure score improved 13.5 ± 20.5 points . CONCLUSIONS In the real-world , post-approval experience in Europe , patients undergoing the MitraClip therapy are high-risk , elderly patients , mainly affected by functional MR . In this patient population , the MitraClip procedure is effective with low rates of hospital mortality and adverse events To prospect ively assess the outcome of percutaneous edge‐to‐edge repair in patients with degenerative versus functional mitral regurgitation ( MR ) The aim of this study was to report on the 30-day and 1-year outcomes of percutaneous mitral valve repair with the MitraClip technique in patients with grade ≥3 + mitral regurgitation ( MR ) at high risk for conventional surgical therapy enrolled in the prospect i ve Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation ( GRASP ) registry . Acute device success was defined as residual MR ≤2 + after clip implantation . The primary safety end point was the rate of major adverse events at 30 days . The primary efficacy end point was freedom from death , surgery for mitral valve dysfunction , or grade ≥3 + MR at 30 days and 1 year . A total of 117 patients were treated . Eighty-nine patients ( 76 % ) presented with functional MR and 28 patients ( 24 % ) with organic MR .  Acute device success was observed in all patients . Device implantation time significantly diminished with experience and varied significantly between cases with 1 versus ≥2 clips . No procedural mortality was recorded . Major adverse events occurred in 4 patients at 30 days ( 4.3 % ) . Deterioration to MR ≥3 + was recorded in 25 % of patients with degenerative MR and 7 % of those with functional MR at 1 year . No surgery for mitral valve dysfunction occurred within 1 year . Freedom from death , surgery for mitral valve dysfunction , or grade ≥3 + MR was 96.4 % and 75.8 % at 30 days and 1 year , respectively . No significant differences were noted in the primary efficacy end point between patients with degenerative MR and those with functional MR . In conclusion , percutaneous mitral valve repair with the MitraClip technique was shown to be safe and reasonably effective in 117 patients from a real-world setting BACKGROUND In a r and omized trial comparing mitral-valve repair with mitral-valve replacement in patients with severe ischemic mitral regurgitation , we found no significant difference in the left ventricular end-systolic volume index ( LVESVI ) , survival , or adverse events at 1 year after surgery . However , patients in the repair group had significantly more recurrences of moderate or severe mitral regurgitation . We now report the 2-year outcomes of this trial . METHODS We r and omly assigned 251 patients to mitral-valve repair or replacement .  Patients were followed for 2 years , and clinical and echocardiographic outcomes were assessed . RESULTS Among surviving patients , the mean ( ±SD ) 2-year LVESVI was 52.6±27.7 ml per square meter of body-surface area with mitral-valve repair and 60.6±39.0 ml per square meter with mitral-valve replacement ( mean changes from baseline , -9.0 ml per square meter and -6.5 ml per square meter , respectively ) . Two-year mortality was 19.0 % in the repair group and 23.2 % in the replacement group ( hazard ratio in the repair group , 0.79 ; 95 % confidence interval , 0.46 to 1.35 ; P=0.39 ) . The rank-based assessment of LVESVI at 2 years ( incorporating deaths ) showed no significant between-group difference ( z score=-1.32 , P=0.19 ) . The rate of recurrence of moderate or severe mitral regurgitation over 2 years was higher in the repair group than in the replacement group ( 58.8 % vs. 3.8 % , P<0.001 ) . There were no significant between-group differences in rates of serious adverse events and overall readmissions , but patients in the repair group had more serious adverse events related to heart failure ( P=0.05 ) and cardiovascular readmissions ( P=0.01 ) . On the Minnesota Living with Heart Failure question naire , there was a trend toward greater improvement in the replacement group ( P=0.07 ) . CONCLUSIONS In patients undergoing mitral-valve repair or replacement for severe ischemic mitral regurgitation , we observed no significant between-group difference in left ventricular 
    Output:
    
Conclusions This meta- analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR .