Hélène Pastor was hit by a hail of bullets outside the L'Archet hospital in the French city of Nice, just a short drive from Monaco, on May 6.
The 77-year-old died today in St Roch hospital after a series of operations failed to save her life.
Her chaffeur, 64-year-old Mohammed Darwish, also died on May 10 due to bullet wounds to his face, neck and stomach.
Investigators now believe two of Italy's most notorious crime syndicates, the 'Ndrangheta and the Camorra, were responsible for the hit.
Police suspects that both gangs are building property portfolios on the French Riviera as they expand their field of operations.
Mrs Pastor's family own buildings worth billions in the area, and detectives believe the Mafia were trying to muscle in.
We are studying frozen images of the attack in an attempt to identify the attackers and witnesses
The heiress, who was close to Monaco's royal family, was visiting her son, Gildo, at the hospital in Nice when a solo gunman struck.
The attack was a classic Mafia-style hit - the gunman used a pump-action shotgun to fire at Mrs Pastor and her chaffeur through the car window, before speeding away in a waiting getaway car driven by another man.
An eyewitness said: "I saw the gunman turn back towards me with his big gun and a bag.
"I thought he was coming for me. I was terrified for my life.'
French MP Eric Ciotti expressed his "extreme shock" at the double assassination, while Prince Albert II of Monaco issued a statement expressing "deep support" for the Pastor family.
Mrs Pastor was the sister of Michel Pastor, the former chairman of AS Monaco football club who died in February.
The Marseille prosecutor has now opened a judicial enquiry into the double murder, parts of which were captured on CCTV.
An investigating source: "We are studying frozen images of the attack in an attempt to identify the attackers and witnesses.
The source said that an alleged blackmailer had contacted the Pastor family and was currently undergoing "psychiatric tests".
The source added: "He claims to know the background to the attack, but his version may be based on what he has seen in the media."
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