Impact of Pulmonary Hypertension on Outcomes in Patients With Functional Mitral Regurgitation Undergoing Percutaneous Edge-to-Edge Repair

Matsumoto, Takashi; Nakamura, Mamoo; Yeow, Wen–Loong; Hussaini, Asma; Ram, Vinny; Makar, Moody; Gurudevan, Swaminatha V.; Trento, Alfredo; Siegel, Robert J.; Kar, Saibal

doi:10.1016/j.amjcard.2014.08.044

Cited by 52 publications

(38 citation statements)

References 19 publications

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“…As for the safety of TMVR in PH, very limited data are available. Our study results are in line with the findings of Matsumoto et al, who demonstrated no difference in 30‐day procedural mortality and morbidity of TMVR in the presence or absence of PH . However, our study comprises a larger sample size and is more representative of U.S. population.…”

Section: Discussionsupporting

confidence: 92%

“…Al‐Bawardy et al demonstrated that in patients undergoing Mitraclip placement, the adjusted hazards ratio was 1.05 for every 5 mmHg increase in mean PAP . All of the studies that demonstrated an increased 1‐year mortality in PH patients after undergoing Mitraclip placement agreed on the safety of the procedure in early post procedure follow‐up, in line with the findings of our study . More studies are needed to compare the mortality rates after TMVR versus surgical repair in PH patients.…”

Section: Discussionsupporting

confidence: 88%

“…Our study results are in line with the findings of Matsumoto et al, who demonstrated no difference in 30-day procedural mortality and morbidity of TMVR in the presence or absence of PH. 21 However, our study comprises a larger sample size and is more representative of U.S. population. They also showed similar immediate procedural They demonstrated that periprocedural mortality was not affected by the presence or absence of PH (P = 0.45).…”

Section: Discussionmentioning

confidence: 99%

“…23 All of the studies that demonstrated an increased 1-year mortality in PH patients after undergoing Mitraclip placement agreed on the safety of the procedure in early post procedure follow-up, in line with the findings of our study. 21,22 More studies are needed to compare the mortality rates after TMVR versus surgical repair in PH patients.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

In‐hospital outcomes of transcatheter mitral valve repair with Mitraclip in patients with pulmonary hypertension: Insights from the National Inpatient Sample

Ahmed

Akintoye

Adegbala

et al. 2018

Cathet Cardio Intervent

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Background Periprocedural outcomes of transcatheter mitral valve repair (TMVR) with Mitraclip in patients with pulmonary hypertension (PH) are not well studied. Methods Patients who underwent TMVR with Mitraclip between 2011 and 2015 were identified using the National Inpatient Sample (NIS). All missing variables were excluded from the analysis and therefore, complete case analysis was performed. Results A total of 1,037 patients underwent TMVR with Mitraclip between 2011 and 2015. The prevalence of PH in these patients was 32.6%. In‐hospital outcomes were compared between PH group and non‐PH group. Inpatient mortality after TMVR was similar between the two groups (3.2% vs. 2.1%, OR 1.57, P = 0.335). There was no statistical significance between the two groups in the rates of hemorrhage requiring transfusion (8.5% vs. 7.2%, OR 1.17, P = 0.587), cardiogenic shock (4.4% vs. 4.5%, OR 0.98, P = 0.951), acute respiratory failure (15.2% vs. 13.1%, OR 1.23, P = 0.460), postoperative sepsis (2.75% vs. 3.9%, OR 0.66, P = 0.340), postoperative deep vein thrombosis or pulmonary embolism (2.7% vs. 3.9%, OR 1.98, P = 0.348). In addition, non‐routine home discharge, median hospital cost and length of stay were similar between the two groups. Conclusion Pre‐existing PH in patients undergoing TMVR with Mitraclip does not adversely affect in‐hospital outcomes in this cohort of patients. Therefore, PH does not carry a prohibitive risk in selecting patients for Mitraclip procedure.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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In‐hospital outcomes of transcatheter mitral valve repair with Mitraclip in patients with pulmonary hypertension: Insights from the National Inpatient Sample

Ahmed

Akintoye

Adegbala

et al. 2018

Cathet Cardio Intervent

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“…A high baseline systolic pulmonary artery pressure (sPAP), an elevated baseline mitral valve mean gradient (MVG), concomitant chronic kidney disease, anemia, peripheral artery disease, and tricuspid regurgitation have been previously reported as independent predictors of poor short-term outcomes after MitraClip procedures [8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

et al. 2021

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Background: The MitraClip procedure was established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, the aim was to evaluate 5-year outcomes after MitraClip. Methods: Consecutive patients undergoing the MitraClip system were prospectively included. All patients underwent clinical follow-up and transthoracic echocardiography. Results: Two hundred sixty-five patients (age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60.5% secondary MR [sMR]). Although high procedural success of 91.3% was found, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04). Five years after the MitraClip procedure, the majority of patients presented with reduced symptoms and improved functional capacity (functional NYHA class: p = 0.0001; 6 minutes walking test: p = 0.04). Sustained MR reduction (≤ grade 2) was found in 74% of patients, and right ventricular (RV) function was significantly increased (p = 0.03). Systolic pulmonary artery pressure (sPAP) was significantly reduced during follow-up only in sMR patients (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, 5-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (MVG) (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality. Conclusions: Transcatheter mitral valve repair with the MitraClip system showed low complication rates and sustained MR reduction with improved RV function and sPAP 5 years after the procedure was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher 5-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and 5-year mortality. (Cardiol J XXXX; XX, X: xx-xx)

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Association of Pulmonary Hypertension With Clinical Outcomes of Transcatheter Mitral Valve Repair

et al. 2020

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pHTN) is associated with increased risk of mortality after mitral valve surgery for mitral regurgitation. However, its association with clinical outcomes in patients undergoing transcatheter mitral valve repair (TMVr) with a commercially available system (MitraClip) is unknown.OBJECTIVE To assess the association of pHTN with readmissions for heart failure and 1-year all-cause mortality after TMVr. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed 4071 patients who underwent TMVr with the MitraClip system from November 4, 2013, through March 31, 2017, across 232 US sites in the Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapy registry. Patients were stratified into the following 4 groups based on invasive mean pulmonary arterial pressure (mPAP): 1103 with no pHTN (mPAP, <25 mm Hg [group 1]); 1399 with mild pHTN (mPAP, 25-34 mm Hg [group 2]); 1011 with moderate pHTN (mPAP, 35-44 mm Hg [group 3]); and 558 with severe pHTN (mPAP, Ն45 mm Hg [group 4]). Data were analyzed from November 4, 2013, through March 31, 2017.INTERVENTIONS Patients were stratified into groups before TMVr, and clinical outcomes were assessed at 1 year after intervention. MAIN OUTCOMES AND MEASURESPrimary end point was a composite of 1-year mortality and readmissions for heart failure. Secondary end points were 30-day and 1-year mortality and readmissions for heart failure. Linkage to Centers for Medicare & Medicaid Services administrative claims was performed to assess 1-year outcomes in 2381 patients. RESULTSAmong the 4071 patients included in the analysis, the median age was 81 years (interquartile range, 73-86 years); 1885 (46.3%) were women and 2186 (53.7%) were men. The composite rate of 1-year mortality and readmissions for heart failure was 33.6% (95% CI, 31.6%-35.7%), which was higher in those with pHTN (27.8% [95% CI, 24.2%-31.5%] in group 1, 32.4% [95% CI, 29.0%-35.8%] in group 2, 36.0% [95% CI, 31.8%-40.2%] in group 3, and 45.2% [95% CI, 39.1%-51.0%] in group 4; P < .001). Similarly, 1-year mortality (16.3% [95% CI, 13.4%-19.5%] in group 1, 19.8% [95% CI, 17.0%-22.8%] in group 2, 22.4% [95% CI, 18.8%-26.1%] in group 3, and 27.8% [95% CI, 22.6%-33.3%] in group 4; P < .001) increased across pHTN groups. The association of pHTN with mortality persisted despite multivariable adjustment (hazard ratio per 5-mm Hg mPAP increase, 1.05; 95% CI, 1.01-1.09; P = .02). CONCLUSIONS AND RELEVANCEThese findings suggest that pHTN is associated with increased mortality and readmission for heart failure in patients undergoing TMVr using the MitraClip system for severe mitral regurgitation. Further efforts are needed to determine whether earlier intervention before pHTN develops will improve clinical outcomes.

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Impact of Pulmonary Hypertension on Outcomes in Patients With Functional Mitral Regurgitation Undergoing Percutaneous Edge-to-Edge Repair

Cited by 52 publications

References 19 publications

In‐hospital outcomes of transcatheter mitral valve repair with Mitraclip in patients with pulmonary hypertension: Insights from the National Inpatient Sample

In‐hospital outcomes of transcatheter mitral valve repair with Mitraclip in patients with pulmonary hypertension: Insights from the National Inpatient Sample

Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

Association of Pulmonary Hypertension With Clinical Outcomes of Transcatheter Mitral Valve Repair

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