Impact of mitral valve treatment choice on mortality according to aetiology

Kortlandt, Friso; Velu, Juliëtte F.; Schurer, Remco A. J.; Branden, Ben Van den; Bouma, Berto J.; Kelder, Johannes C.; Eefting, Frank D.; Swaans, Martin J.; Rensing, Benno J.; Baan, Jan; Heyden, Jan Van der

doi:10.4244/eij-d-18-00874

Cited by 15 publications

(13 citation statements)

References 21 publications

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“…Functional mitral regurgitation (FMR) is common in patients with advanced systolic heart failure. 1,[12][13][14][15] Despite optimal guideline-directed medical therapy, the prognosis remains poor. 13,14,16 Different transcatheter treatments of FMR have been, or are being, developed.…”

Section: Discussionmentioning

confidence: 99%

“…These results compare favourably with the outcomes of medically treated patients, reported in several recent studies. In several studies evaluating patients treated with medical therapy, the 3–5 year long‐term mortality was over 50% in patients with moderate or severe FMR 12,15,16 . In COAPT and MITRA‐FR, the 2 year mortality rate in the medically treated patients were 46% and 34.2%, respectively, with a 55% mortality at 3 years in medically managed patients in COAPT 2,19,20,23 .…”

Section: Discussionmentioning

confidence: 99%

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Long‐term prognosis of patients treated by coronary sinus‐based percutaneous annuloplasty: single centre experience

Lipiecki¹,

Fahrat²,

Monzy³

et al. 2020

ESC Heart Failure

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Aims This study aims to report long-term mortality, echocardiographic, and clinical outcomes of patients receiving treatment for functional mitral regurgitation (FMR) with the Carillon device. Methods and results This was a single centre analysis of prospectively collected data from patients treated with the Carillon Mitral Contour System for symptomatic congestive heart failure despite guideline-directed medical therapy, who were included from a single centre from the TITAN II study. All patients presented with New York Heart Association (NYHA) class 2 or greater symptoms, grade 2+ to 4+ FMR, left ventricular enlargement, and reduced ejection fraction. Surviving patients were evaluated for long-term follow-up post-procedure, averaging 6.9 years. Fifteen (15) patients (mean age 72 years, 60% male, 100% NYHA class III or IV, 50% MR grade 3+ or 4+) were treated with the Carillon device. The Kaplan-Meier mortality rate was 40% at 6 years of follow-up. Long-term survival through 6 years was associated with echocardiographic improvement in mitral regurgitation (change in effective regurgitant orifice area in survivors versus non-survivors from baseline to 1 year follow-up, À9.0 ± 5.6 vs. À1.7 ± 1.5, P = 0.02) and clinical status at 12 months (difference in NYHA at 1 year follow-up between survivors versus non-survivors, P = 0. 05) which was sustained throughout follow-up. All patients at 6 year follow-up had ≤2+ MR, with 6 of 7 having 0-1+ MR. Left ventricular end-diastolic volume was reduced from 154.0 ± 65.7 mL at baseline to 104.5 ± 59.2 mL at 6 year follow-up, P = 0.03 in survivors with both measurements. Conclusions Among patients with congestive heart failure treated with the Carillon device, long-term survival is associated with favourable 1 year and sustained improvements in mitral regurgitation, left ventricular volume, ejection fraction, and clinical status.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐term prognosis of patients treated by coronary sinus‐based percutaneous annuloplasty: single centre experience

Lipiecki¹,

Fahrat²,

Monzy³

et al. 2020

ESC Heart Failure

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“…While this study represented a high throughput of patient data, there was the potential of patient overlap with other studies in the analysis, as a result this study was excluded to try to maintain validity. Eventually, 12 studies 12,22–32 were included in the final analysis (1 RCT, 11 retrospective analyses).…”

Section: Resultsmentioning

confidence: 99%

Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?

Khader

Allaf

et al. 2021

J Card Surg

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Background Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR. Methods A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies). Results The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009). Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63−4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77–0.99]; p < .001) with considerable heterogeneity (I2 > 90%; p < .001). The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188−0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19−0.46]; p < .001) during midterm follow up. Long term survival (4–5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35−1.41]; p = .323). Conclusions This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.

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“…In a previous retrospective observational study mitral interventions (either transcatheter or surgical) were compared with conservative management. 8 Conservative management in patients with FMR was associated with a higher mortality compared with PMVR (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.34-2.39), with no significant mortality difference identified between the PMVR and surgical arms (HR, 0.86; 95% CI, 0.54-1.38). Of note, the death rate was numerically higher for patients treated with PMVR vs surgery (33% vs 23%), in keeping with the higher mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) II observed in this group of patients (8.9 vs 4.7; P < 0.001).…”

Section: Percutaneous Mitral Valve Repair For Patients With Hf and Rementioning

confidence: 99%

“…In 2018, 2 randomized controlled trials were published that compared the efficacy of PMVR using the MitraClip device (Abbott Structural Heart) in addition to guidelinedirected medical therapy (GDMT) with GDMT alone in patients with FMR for whom mitral valve surgery was not deemed appropriate. 7,8 These trials differed with respect to patient characteristics and outcome definitions. The Percutaneous Repair with the MitraClip device for Severe Functional/Secondary Mitral Regurgitation (MITRA-FR) 9 trial enrolled 304 patients with at least moderate-severe FMR (mean effective regurgitant orifice area of 31 mm 2 ) and severe LV dilatation (indexed left ventricular end-diastolic volume of 135 AE 37 mL/m 2 ).…”

Section: Percutaneous Mitral Valve Repair For Patients With Hf and Rementioning

confidence: 99%

CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis

O’Meara

McDonald

Chan

et al. 2020

Canadian Journal of Cardiology

114

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The disclosure information of the authors and reviewers is available from the CCS on their guidelines library at www.ccs.ca.This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.

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Impact of mitral valve treatment choice on mortality according to aetiology

Cited by 15 publications

References 21 publications

Long‐term prognosis of patients treated by coronary sinus‐based percutaneous annuloplasty: single centre experience

Long‐term prognosis of patients treated by coronary sinus‐based percutaneous annuloplasty: single centre experience

Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?

CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis

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