Can we set a threshold for the learning curve of MitraClip procedures?

This article refers to ‘Centre procedural volume and adverse in-hospital outcomes in patients undergoing percutaneous transvenous edge-to-edge mitral valve repair using MitraClip® Germany’ by K. Keller et al., published this issue on pages 1380–1389. Percutaneous treatment of regurgitation (MR) with MitraClip (Abbott Vascular, Chicago, IL, USA) is a consolidated therapy for different anatomies. The recent results the COAPT (Cardiovascular Outcomes Assessment Therapy Heart Failure Patients Functional Mitral Regurgitation) MITRA-FR (Percutaneous Repair Device Severe Functional/Secondary trials have clearly demonstrated necessity meticulous screening achieve best patient's outcome.1, 2 In particular, negative deeply been influenced limited operator's experience, which translated higher rate complications (MITRA-FR: 14.6% vs. COAPT: 8.5%) residual moderate severe MR at end procedure (MITRA-FR 9% 5%). These findings are key elements determination outcome since post-procedural impact prognosis.3 Data from Transcatheter Valve registry corroborate these findings, showing better fewer after 50 cumulative procedures. Nevertheless, few data support intuitive findings.4 First all, experienced skilled operators able treat challenging anatomies without any harm patients. Technological improvements availability larger models will extend boundaries more complex anatomies; moreover, high-volume centres success presumably assured interaction multiple players such as echocardiographists, heart failure specialists, cardiac surgeons anaesthesiologists that experience clinical scenarios. corroborating evidence strict between specialists attested opposite trends number surgical procedures valve: paradigm shift coming possible thanks professions. We can state Teams hospitals included analysis were expert selecting appropriate relation centre. truism ‘we should do only what we do’ confirmed! An aspect was not evaluated large survey decreasing MR. Without dismissing value ‘primum non nocere’, intervention statement ‘make benefit’ all our efforts must go direction guaranteeing result Can low-volume same degree technical decrease grade centres? Hopefully further studies address question. A.M. received an institutional grant Boston Scientific part advisory board Scientific. Conflict interest: none declared.