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Acute kidney injury (AKI) is a serious complication following cardiac surgery and transcatheter valve therapies [1, 2]. Limited data exist on the occurrence of AKI associated with MitraClip implantation in high risk patients. We here report the incidence, predictive factors and prognostic value of AKI following MitraClip treatment in high-risk surgical patients in our experience. From October 2008 to July 2012, 126 consecutive high-risk patients with degenerative and functional MR underwent MitraClip implantation in our institution. All patients were assessed by a dedicated Heart Team according to a standardized preoperative protocol. AKI was defined according to the modified RIFLE criteria (stages 2 and 3)[3]. No contrast was used during MitraClip procedure. Informed consent was obtained from each patient and the study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's ethical committee. AKI occurred in 30 patients (23.8%)(22 patients in stage 2 and 8 patients in stage 3), with 8 patients (6.8%) requiring dialysis during the index hospitalization. Baseline clinical and echocardiographic characteristics of the study population grouped according to the occurrence of AKI are shown in Table 1: patients who presented AKI had higher baseline pro-BNP levels and lower EF, while preoperative eGFR was not significantly different. Patients who presented AKI had more frequently preoperative anemia (Hb b 11 g/dl in 31.1% vs. 11.4%; p= 0.01). No differences were observed in terms of history of hypertension, diabetes, previous episodes of heart failure and associated coronary …