Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review

Iliadis, Christos; Lee, Samuel; Kuhr, Kathrin; Matzik, Anna-Sophie; Michels, Guido; Rudolph, Volker; Baldus, Stephan; Pfister, Roman

doi:10.1007/s00392-017-1150-x

Cited by 26 publications

(26 citation statements)

References 78 publications

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“…Second, FMR is a common finding among patients with HFrEF and has a negative impact on exercise capacity and clinical outcomes on standalone medical therapy. [11][12][13] Although only modest increments in LVEF have been reported in this scenario, these changes, alongside the reduction in regurgitant volume, imply an improvement in antegrade ejection flow that might be one of the underlying mechanisms for a better cardiopulmonary performance. 10 And fourth, this haemodynamic enhancement has translated into positive left ventricular remodelling and improvement in clinical symptoms, quality of life, and 6 min walk test in different series.…”

Section: Discussionmentioning

confidence: 89%

“…10 And fourth, this haemodynamic enhancement has translated into positive left ventricular remodelling and improvement in clinical symptoms, quality of life, and 6 min walk test in different series. [11][12][13] Although only modest increments in LVEF have been reported in this scenario, these changes, alongside the reduction in regurgitant volume, imply an improvement in antegrade ejection flow that might be one of the underlying mechanisms for a better cardiopulmonary performance. 14 Given the good correlation reported between 6 min walk test and estimated VO 2 , 15 this result go alongside with prior findings.…”

Section: Discussionmentioning

confidence: 89%

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MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation

et al. 2019

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Aims The aim of this study is to evaluate changes in cardiopulmonary exercise test (CPET) after percutaneous mitral valve repair (PMVR) with MitraClip in patients with heart failure with reduced ejection fraction who are potentially candidates for heart transplantation or destination left ventricular assist device. Methods and results Prospective registry of all consecutive patients with heart failure with reduced ejection fraction and functional mitral regurgitation (MR) underwent elective PMVR between October 2015 and March 2018 in our institution. Patients with preserved or mid‐range left ventricular ejection fraction (>40%), advanced age (>75 years old), or severe co‐morbidities (end‐stage organ damage) were not included. Treadmill exercise testing with respiratory gas exchange analysis was carried out in 11 patients (male, 72.7%; median age, 67 years old) within the month prior to the procedure and at 6 month follow‐up. PMVR was successfully performed in all patients. At 6 month follow‐up, PMVR was associated with an improvement in New York Heart Association functional class (P = 0.021) and a reduction in MR severity (P = 0.013) and N‐terminal pro‐brain natriuretic peptide levels (2805 [1878–5022] vs. 1485 [654–3032] pg/mL; P = 0.012). All patients completed pre‐procedural and post‐procedural CPET, and all the studies showed a respiratory exchange ratio ≥1 and were consistent with sufficient exercise effort. Compared with pre‐procedural CPET, patients showed a significant increase in exercise time (295 [110–335] vs. 405 [261–540] s; P = 0.047), VO2 (9.8 [9.1–13.4] vs. 13.5 [12.1–16.8] mL/kg/min; P = 0.033), ventilatory anaerobic threshold (510 [430–950] vs. 850 [670–1070] mL/kg/min; P = 0.033), peak O2 pulse (7.2 [4.3–8.6] vs. 8.3 [6.2–11.8] mL/beat; P = 0.033), and workload (5 [3–6] vs. 6 [5–8] metabolic equivalents; P = 0.049). Conclusions Percutaneous mitral valve repair with MitraClip was associated with an enhancement in cardiopulmonary performance in patients with systolic heart failure and secondary MR.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation

et al. 2019

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“…PMVR with MitraClip® has proven to persistently reduce MR with low rates of procedural complications in patients at high surgical risk [18] . 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] .…”

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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“…Thus, although specific clinical trials for this patient population are lacking, it appears prudent to assess first the potentials of other advanced therapies including heart transplantation or left-ventricular assist devices, which may have a particular benefit in this high-risk population. However, if such advanced therapies are not indicated or available and if the life expectancy is still beyond 1 year, MitraClip therapy may still be considered as palliative treatment in these patients due to the symptomatic improvement seen in COAPT (unpublished data) and in earlier observational studies [12,13] (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

Role of percutaneous edge-to-edge repair in secondary mitral regurgitation after MITRA-FR and COAPT

et al. 2019

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Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review

Cited by 26 publications

References 78 publications

MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation

MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation

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

Role of percutaneous edge-to-edge repair in secondary mitral regurgitation after MITRA-FR and COAPT

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