Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

Benito‐González, Tomas; Estévez‐Loureiro, Rodrigo; Villablanca, Pedro A.; Armeni, Patrizio; Iglesias-Garriz, Ignacio; Minguito, Carlos; Garrote, Carmen; Prado, Armando Pérez de; Tundidor-Sanz, Elena; Gualis, Javier; Fernández‐Vázquez, Felipe

doi:10.1016/j.carrev.2019.06.008

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…And, among those, patients with advanced HF and recurrence of moderate‐to‐severe or severe MR after a primary successful MitraClip procedure are an especially challenging patient cohort. 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

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Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

et al. 2021

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Aim Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for severe mitral regurgitation (MR) in advanced stages of heart failure (HF). However, progressive left ventricular dilation in these patients may lead to recurrent MR after PMVR and consequent re-do MitraClip implantation. Here, we describe the characteristics and outcomes of this clinical scenario. Methods and resultsPatients with systolic HF and functional MR undergoing a re-do MitraClip procedure were retrospectively analysed. Inclusion criteria were age ≥18 years, technical, device and procedural success at first MitraClip procedure, functional MR and systolic HF with an ejection fraction (EF) of <45%. Seventeen out of 684 patients undergoing PMVR with the MitraClip device at our institution between September 2009 and July 2019 were included. All patients displayed advanced HF with an EF of 20% (±9.9) and highly elevated N-terminal pro-brain natriuretic peptide. Technical success of the re-do MitraClip procedure was 100%, whereas procedural and device success were only achieved in 11 patients (65%). Unsuccessful re-do procedures were related to lower EF and implantation of more than one clip at initial procedure. However, despite reduction in MR grade and no occurrence of significant mitral stenosis after the procedure, the mortality during 12 months follow-up remained high (8 of 17; 47%). Conclusions In a cohort of patients with advanced HF undergoing PMVR, re-do MitraClip procedure was feasible, but procedural success was unsatisfactory and morbidity and mortality remained high, possibly reflecting the advanced stage of HF in these patients.

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Section: Discussionmentioning

confidence: 99%

“…Taken together, these data reflect the vulnerability of patients with recurrence of MR after successful index intervention. And, among those, patients with advanced HF and recurrence of moderate‐to‐severe or severe MR after a primary successful MitraClip procedure are an especially challenging patient cohort 32,33 …”

Section: Discussionmentioning

confidence: 99%

Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

et al. 2021

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“…To date, conflicting results of recently published RCTs regarding the survival impact of MitraClip ® implantation over stand-alone medical treatment in patients with FMR makes this question yet unsolved (34).…”

Section: Discussionmentioning

confidence: 99%

Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip®

Benito‐González

Freixa

Godino³

et al. 2020

Ann Transl Med

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Background: Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods:We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction (LVEF), functional mitral regurgitation (FMR) grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up.Results: Ninety-three patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-month follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0±17.8 vs. 2.7±13.5, P=0.002), sustained VT or ventricular fibrillation (0.9±2.5 vs. 0.5±2.9, P=0.012) and ICD antitachycardia therapies (2.5±12.0 vs. 0.9±5.0, P=0.033) were observed.Conclusions: PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.

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“…Furthermore, observational registries have shown a significant improvement in functional class, 6-minute walk test and quality of life [19] . More recently, data from randomized controlled trials suggest that there might be a survival benefit of MitraClip® compared to stand-alone medical therapy in patients with functional MR [20][21][22] . Nevertheless, selection of patients in order to find those who will benefit the most from PMVR and avoid futility is still extremely challenging.…”

Section: Discussionmentioning

confidence: 99%

The prognostic impact of frailty in patients undergoing percutaneous mitral valve repair

Benito‐González¹,

Estévez‐Loureiro²,

Castillo³

et al. 2020

MIS

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Aim: Percutaneous mitral valve repair (PMVR) with MitraClip® has proven to be an effective therapy to reduce mitral regurgitation in patients at high risk for conventional surgery. This population is currently characterized by advance age and high prevalence of comorbidities. Our aim was to evaluate the prevalence of frailty in a cohort of patients undergoing PMVR and its impact on clinical outcomes during follow-up. Methods: A prospective registry was performed including all consecutive patients who underwent elective PMVR between June 2014 and March 2018 in our institution. Frailty was evaluated at admission with the functional FRAIL scale. In-hospital and 30-day procedural outcomes were collected. Clinical follow up was carried out including New York Heart Association (NYHA) functional class, heart failure hospitalization and death. Results: Overall, 70 patients were included (mean age 75.3 ± 9.9 years, 65.7% male). Among them, 27 patients (38.6%) had a pre-procedural FRAIL score greater than 2, meeting frailty criteria. No differences between frail and non-frail patients were found in technical success (P = 1.0) or 30-day device success (P = 0.739). At six months follow up, both groups showed a significant improvement in NYHA functional class compared to baseline (frail: P = 0.002; non-frail: P < 0.001). During a median follow up of 675 (range 416-976) days, frailty patients had a higher incidence of HF admission and all-cause mortality (P = 0.013). In multivariate COX regression analysis, FRAIL score greater than 2 was significantly related to the primary composite endpoint (HR = 2.45; 95%CI: 1.02-5.88; P = 0.044).

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Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

Cited by 10 publications

References 24 publications

Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip®

The prognostic impact of frailty in patients undergoing percutaneous mitral valve repair

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