Comparison of Outcomes of Percutaneous MitraClip Versus Surgical Repair or Replacement for Degenerative Mitral Regurgitation in Octogenarians

Buzzatti, Nicola; Maisano, Francesco; Latib, Azeem; Taramasso, Maurizio; Denti, Paolo; Canna, Giovanni La; Colombo, Antonio; Alfieri, Ottavio

doi:10.1016/j.amjcard.2014.11.031

Cited by 31 publications

(36 citation statements)

References 20 publications

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“…Transcatheter mitral technologies have developed as a viable option to treat high-risk and inoperable patients with severe MR, having shown promising early outcomes, especially in terms of procedural safety. 27 , 28 , 29 , 30 , 31 , 32 Buzzatti and colleagues 30 recently published their results comparing the outcomes of patients aged 80 years or more, affected by isolated degenerative MR, who underwent isolated transcatheter (n = 25) or surgical (n = 35, 29 repairs and 6 replacements) mitral intervention. Follow-up overall mortality was higher in the MitraClip group (MitraClip System, Abbott Vascular, Inc) than in the surgery group, although after the first 30 days, only 1 of 5 deaths observed in the MitraClip group was cardiac related.…”

Section: Discussionmentioning

confidence: 99%

“…Transcatheter mitral technologies are emerging as a viable option to treat high-risk and inoperable patients with mitral valve disease. 27 , 28 , 29 , 30 , 31 , 32 These have shown promising early outcomes, especially in terms of procedural safety, and have being increasingly used in otherwise fit octogenarians requiring intervention for degenerative mitral valve disease. To this end, a clear understanding of the risks and benefits of mitral surgery in octogenarians in the current era is needed for rational decision-making regarding the best management option in this cohort of patients.…”

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confidence: 99%

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Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study

Chivasso

Bruno

Farid

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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ObjectivesAn increasing number of octogenarians are referred to undergo mitral valve surgery for degenerative disease, and percutaneous approaches are being increasingly used in this subgroup of patients. We sought to determine the survival and its predictors after Mitral Valve Surgery in Octogenarians (MiSO) in a multicenter UK study of high-volume specialized centers.MethodsPooled data from 3 centers were collected retrospectively. To identify the predictors of short-term composite outcome of 30 days mortality, acute kidney injury, and cerebrovascular accident, a multivariable logistic regression model was developed. Multiple Cox regression analysis was performed for late mortality. Kaplan–Meier curves were generated for long-term survival in various subsets of patients. Receiver operating characteristic analysis was done to determine the predictive power of the logistic European System for Cardiac Operative Risk Evaluation.ResultsA total of 247 patients were included in the study. The median follow-up was 2.9 years (minimum 0, maximum 14 years). A total of 150 patients (60.7%) underwent mitral valve repair, and 97 patients (39.3%) underwent mitral valve replacement. Apart from redo cardiac surgery (mitral valve repair 6 [4%] vs mitral valve replacement 11 [11.3%], P = .04) and preoperative atrial fibrillation (mitral valve repair 79 [52.6%] vs mitral valve replacement 34 [35.1%], P < .01), there was no significant difference in terms of any other preoperative characteristics between the 2 groups. Patient operative risk, as estimated by logistic European System for Cardiac Operative Risk Evaluation, was lower in the mitral valve repair group (10.2 ± 11.8 vs 13.7 ± 15.2 in mitral valve replacement; P = .07). No difference was found between groups for duration of cardiopulmonary bypass and aortic crossclamp times. The 30-day mortality for the whole cohort was 13.8% (mitral valve repair 4.7% vs mitral valve replacement 18.6%; P < .01). No differences were found in terms of postoperative cerebrovascular accident (2% vs 3.1%; P = .9), acute kidney injury requiring dialysis (6.7% vs 13.4%; P = .12), and superficial or deep sternal wound infection (10% vs 16.5%, P = .17; 2% vs 3.1%, P = .67, respectively). The final multiple regression model for short-term composite outcome included previous cardiac surgery (odds ratio [OR], 4.47; 95% confidence interval [CI], 1.37-17.46; P = .02), intra-aortic balloon pump use (OR, 4.77; 95% CI, 1.67-15.79; P < .01), and mitral valve replacement (OR, 7.7; 95% CI, 4.04-14.9; P < .01). Overall survival for the entire cohort at 1, 5, and 10 years was 82.4%, 63.7%, and 45.5% (mitral valve repair vs mitral valve replacement: 89.9% vs 70.7% at 1 year, 69.6% vs 54% at 5 years, and 51.8% vs 35.5% at 10 years; P = .0005). Cox proportional hazard model results showed mitral valve replacement (hazard ratio, 1.88; 95% CI, 1.22-2.89; P < .01) and intra-aortic balloon pump use (hazard ratio, 2.54; 95% CI, 1.26-5.13; P < .01) to be independent predictor factors affecting long-term survival. Logisti...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study

Chivasso

Bruno

Farid

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…As compare to surgical mitral valve intervention, trans-catheter mitral valve repair with MitraClip device appears remarkably safe in the elderly population in terms of acute mortality and complications 19). From Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) registry, MitraClip was shown to be safe and effective in most patients, with similar hospital length of stay, 1-year clinical outcomes and re-hospitalization rates in either elderly or younger patients 20).…”

Section: Discussionmentioning

confidence: 99%

Can Elderly Patients with Severe Mitral Regurgitation Benefit from Trans-catheter Mitral Valve Repair?

Lee¹,

Sung²,

Huang³

et al. 2019

Korean Circ J

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Background and Objectives Age is a traditional risk factor for open-heart surgery. The efficacy and safety of transcatheter edge-to-edge mitral valve repair, using MitraClip (Abbott Vascular), has been demonstrated in patients with severe mitral regurgitation (MR). Since octogenarians or older patients are usually deferred to receive open-heart surgery, the main interest of this study is to elucidate the procedural safety and long-term clinical impact of MitraClip in elderly patients. Methods Patients with symptomatic severe MR were evaluated by the heart team. For those with high or prohibitive surgical risks, transcatheter mitral valve repair was performed in hybrid operation room. Transthoracic echocardiography (TTE), blood tests, and six-minute walk test (6MWT) were performed before, 1-month, 6-months, and 1 year after index procedure. Results A total of 46 consecutive patients receiving MitraClip procedure were enrolled. Nineteen patients (84.2±4.0 years) were over 80-year-old and 27 (73.4±11.1 years) were younger than 80. Compare to baseline, the significant reduction in MR severity was achieved after the procedure and sustained. All the patients benefited from significant improvement in New York Heart Association functional class. The 6-minute walk test (6MWT) increased from 259±114 to 319±92 meters (p=0.03) at 1 year. The overall 1-year survival rate was 80% in the elderly and 88% in those <80 years, p=0.590. Baseline 6MWT was a predictor for all-cause mortality (odds ratio, 0.99; 95% confidence interval, 0.982–0.999; p=0.026) after the MitraClip procedure. Conclusions Trans-catheter edge-to-edge mitral valve repairs are safe and have positive clinical impact in subjects with severe MR, even in advanced age.

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“…For low- or intermediate-risk elderly patients with primary MR, MitraClip has been associated with a lower incidence of acute postoperative complications and increased survival within 1 year compared to surgery, but at the expense of greater rates of MR recurrence and reduced survival beyond the 1-year period. 32,33…”

Section: Treatment Strategies For Primary Mrmentioning

confidence: 99%

Contemporary Status of Percutaneous Transcatheter Edge-to-Edge Repair: Is It a Complement or Replacement to Mitral Surgery?

Shim

Percy

Hirji

et al. 2020

Innovations�(Phila)

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Transcatheter mitral valve repair devices borrow from the concept of surgical edge-to-edge approximation and are becoming increasingly used in patients with both primary and functional mitral regurgitation. The application of these new devices is expanding globally; however, debates between which patients are amenable to surgery vs. percutaneous approaches are ongoing. As new trials and regulatory approvals have evolved, the indications for transcatheter approaches have expanded, in a way that is complementaty to existing indications for surgical repair. In general, the treatment of mitral regurgitation should be stratified based on underlying pathophysiology and anatomy by a multidisciplinary team including cardiac surgeons and interventional cardiologists. This review aims to provide practical approaches to patient selection and treatment strategies for mitral regurgitation based on historical data and recently published trials, with a focus on the distinction between surgical and transcatheter mitral therapies.

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Comparison of Outcomes of Percutaneous MitraClip Versus Surgical Repair or Replacement for Degenerative Mitral Regurgitation in Octogenarians

Cited by 31 publications

References 20 publications

Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study

Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study

Can Elderly Patients with Severe Mitral Regurgitation Benefit from Trans-catheter Mitral Valve Repair?

Contemporary Status of Percutaneous Transcatheter Edge-to-Edge Repair: Is It a Complement or Replacement to Mitral Surgery?

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