Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Buzzatti, Nicola; Denti, Paolo; Scarfò, Iside; Giambuzzi, Ilaria; Schiavi, Davide; Ruggeri, Stefania; Castiglioni, Alessandro; Bonis, Michele De; Canna, Giovanni La; Alfieri, Ottavio

doi:10.1002/ccd.28029

Cited by 22 publications

(21 citation statements)

References 31 publications

(49 reference statements)

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“…Higher all-cause mortality at follow-up in sMR patients was found, and might be explained by the advanced age of sMR patients, a more impaired baseline LV and RV function compared to pMR patients. Similar findings were presented in the Buzzatti et al [22] showed higher 5-year mortality (about 50%) with good mid-term results including reduction of MR and improved symptoms in 339 patients with relevant MR. In line with current results, they found pronouncedly worse outcomes and higher mortality in patients with secondary MR associated with worse LV remodelling and function.…”

Section: Survival and Re-intervention Ratessupporting

confidence: 88%

“…Moreover, Matsumoto et al [10] found that pre-existing pulmonary hypertension was a strong predictor of higher all-cause mortality 12 months after the MitraClip procedure. The association between worse outcomes and advanced heart disease and symptoms have been presented by Buzzatti et al [22] in more than 300 patients with relevant MR at 5-year follow-up. The cited study validates present findings; elevated baseline sPAP values are an independent predictor of (> 45 mmHg) adverse outcomes and (> 50 mmHg) all-cause mortality at 5-year follow-up.…”

Section: Predictors Of Adverse Outcomementioning

confidence: 89%

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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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Section: Survival and Re-intervention Ratessupporting

confidence: 88%

Section: Predictors Of Adverse Outcomementioning

confidence: 89%

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

et al. 2021

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“…7 Comparable to the surgical setting, higher rMR grades after MitraClip therapy are also associated with a recurrence of severe MR grades and higher rates of rehospitalization due to heart failure. [8][9][10][11][12] Based on these findings and the largest single centre MitraClip experience so far, the aim of this retrospective observational study was to assess the impact of very low and low rMR (≤1+) grades at discharge on long-term outcome and durability in comparison to moderate (2+) and more severe rMR (≥3+) grades in patients with FMR.…”

Section: Introductionmentioning

confidence: 99%

The impact of residual mitral regurgitation after MitraClip therapy in functional mitral regurgitation

Reichart¹,

Kalbacher²,

Rübsamen³

et al. 2020

European J of Heart Fail

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“…Previous trials and registries have assessed the prognostic impact of NYHA functional class 26,27 . A recently conducted multicentre study involving more than 800 patients from the German Mitral Valve Registry showed a lower survival rate at short-term follow-up in patients with baseline NYHA class IV in comparison to those on other functional classes 26 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

Polimeni

Albanese

Salerno

et al. 2020

Sci Rep

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Percutaneous mitral valve repair has been increasingly performed worldwide after approval. We sought to investigate predictors of clinical outcome in patients with mitral regurgitation undergoing percutaneous valve repair. The MITRA-UMG study, a single-centre registry, retrospectively collected consecutive patients with symptomatic moderate-to-severe or severe MR undergoing MitraClip therapy. The primary endpoint was the composite of cardiovascular death or rehospitalization for heart failure. Between March 2012 and July 2018, a total of 150 consecutive patients admitted to our institution were included. Procedural success was obtained in 95.3% of patients. The composite primary endpoint of cardiovascular death or rehospitalization for HF was met in 55 patients (37.9%) with cumulative incidences of 7.6%, 26.2%, at 30 days and 1-year, respectively. In the Cox multivariate model, NYHA functional class and left ventricular end-diastolic volume index (LVEDVi), independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan–Meier analysis, a LVEDVi > 92 ml/m2 was associated with an increased incidence of the primary endpoint. In this study, patients presenting with dilated ventricles (LVEDVi > 92 ml/m2) and advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis after percutaneous mitral valve repair.

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Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Cited by 22 publications

References 31 publications

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

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

The impact of residual mitral regurgitation after MitraClip therapy in functional mitral regurgitation

Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

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