MitraClip procedure as ‘bridge to list’, the ultimate therapeutic option for end‐stage heart failure patients not eligible for heart transplantation due to severe pulmonary hypertension

Gritti, Valeria; Ghio, Stefano; Crescio, Valeria; Magrini, Giulia; Turco, Annalisa; Gazzoli, Fabrizio; Ferrario, Maurizio; Raineri, Claudia; Visconti, Luigi Oltrona

doi:10.1177/2045894018791871

Cited by 13 publications

(5 citation statements)

References 8 publications

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“…These data may be particularly relevant for patients who are not eligible for heart transplantation due to PH with elevated PVR. In these patients, a persistent reduction of PVR may lead to eligibility for heart transplantation, as already suggested 15,16 . Therefore, MitraClip may not be conclusive in the management of Cpc‐PH patients as it is not able to treat the pre‐capillary component due to pulmonary vascular remodelling; however, it may be eventually considered as a “bridge to candidacy” strategy to try to reduce PVR and thus make an ineligible patient suitable for heart transplantation or as a “palliative therapy” in patients with end‐stage HF ineligible for transplantation.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic impact of MitraClip in patients with functional mitral regurgitation and pulmonary hypertension

Mandurino-Mirizzi

Raineri

Magrini

et al. 2021

Eur J Clin Investigation

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Transcatheter mitral valve repair (TMVr) using the MitraClip system (Abbott Vascular, Inc.) has emerged as a possible therapeutic intervention in patients with heart failure and reduced left ventricular (LV) ejection fraction (HFrEF) with significant functional mitral regurgitation (FMR), being effective in reducing symptoms and improving clinical outcomes in selected patients. [1][2][3] Pulmonary hypertension (PH) is commonly found in patients with HFrEF and FMR. Baseline PH negatively affects prognosis in patients undergoing surgical mitral valve intervention 4 and TMVr. [5][6][7] However, data on MitraClip procedure in patients with FMR and PH are scarce and most haemodynamic studies on MitraClip were performed during or shortly after the procedure, in patients under general anaesthesia, inotropes and vasopressors drugs. [8][9][10] This study aimed at evaluating the haemodynamic impact of MitraClip in conscious patients with HFrEF, significant FMR and PH, comparing the results in patients with different types of PH. | METHODSOur registry prospectively enrolled all consecutive HFrEF patients affected by moderate-to-severe or severe (3+ or 4+/4+) FMR, who consecutively underwent MitraClip intervention between December 2012 and September 2019. FMR was defined as MR caused by noncomplete leaflet coaptation due to LV remodelling.An analysis of right heart catheterization (RHC) was performed in conscious patients at baseline and 6 months after MitraClip as an outpatient procedure. Trans-thoracic and trans-oesophageal echocardiography were repeated at the same times.Before right heart catheterization (RHC) and echocardiographic evaluations and final Heart Team discussion, all patients underwent coronary angiography and eventually percutaneous coronary intervention as part of the protocol for transcatheter procedure feasibility and eligibility evaluation. All patients enrolled were on optimal medical therapy at the moment of the Heart Team discussion.MitraClip procedure was performed as previously described 11 ; procedural success was defined as residual MR ≤2, in absence of failure (abortion of the procedure and conversion to open surgery), at the end of the procedure. 12 Pulmonary hypertension was defined as mean PAP (mPAP) ≥25 mmHg at RHC. Endpoints of interest were longitudinal haemodynamic variables measured or computed during repeated RHC, as previously reported. 13 According to European Guidelines, we divided patients according to PH type: combined post-and pre-capillary-PH (Cpc-PH) was defined as mPAP ≥25 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, diastolic pulmonary gradient (DPG) ≥7 mmHg and/or pulmonary vascular resistance (PVR) >3 WU; isolated post-capillary-PH (Ipc-PH) as mPAP ≥25 mmHg, PAWP >15 mmHg, DPG <7 mmHg and/or PVR ≤3 WU.The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki, patients signed an informed consent, and data collection was approved by our Ethical Committee.Categorical variables were expressed as count (percentage) and compared with Fishe...

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Section: Discussionmentioning

confidence: 99%

Haemodynamic impact of MitraClip in patients with functional mitral regurgitation and pulmonary hypertension

Mandurino-Mirizzi

Raineri

Magrini

et al. 2021

Eur J Clin Investigation

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“…24 Others have reported similar results in case reports and case series. [25][26] Our study has some limiting factors that should be considered. These include the retrospective recruitment of cases, the small number of patients and lack of long-term follow-up to clarify the mortality benefit of MitraClip and improvement of HF course after reduction of severe MR.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Mitral Valve Repair via MitraClip in Patients Aged <65 Years: Multicentre 2-year Outcomes

Mohammed

Farah²,

Plicht³

et al. 2023

ICR

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Background: Transcatheter mitral valve repair (TMVR) using the MitraClip has become a well-established interventional therapy and is usually performed in elderly patients. The objective of this study was to assess 2-year clinical outcomes of TMVR in patients aged <65 years at three heart centres with severe mitral regurgitation (MR) and no surgical options. Methods: A retrospective study analysed data of 36 patients aged <65 years treated with TMVR . All patients were refused surgery by Heart Team decision. Baseline MR was assessed by biplane vena contracta width in two perpendicular views (mean 8.35 ± 1.87 mm). Degenerative MR was detected in 11 patients (30.6%); functional MR was detected in 25 patients (69.4%). Results: Acute procedural success was accomplished in 88.9% of patients. No procedure-related mortality during the first 30 days was detected. Over an average of 2 years of follow-up, all-cause mortality was 19.4% and cardiovascular death was 11.1% owing to advanced heart failure. The average follow-up period was 25.8 months (median was 20 months). Statistically significant difference (p-value <0.01) was detected for N-terminal prohormone of brain natriuretic peptide (pg/ml) at baseline (mean 9,870 ± 10,819; median 7,748) compared to follow-up visits (mean 7,645 ± 11,292; median 3,263). New York Heart Association functional class improvement was achieved in 69% of patients. A second intervention (reclipping) was required in two patients to correct recurrent significant MR. Conclusion: TMVR in patients aged <65 years refused surgical repair provides satisfactory clinical outcomes at 2 years. Future studies should evaluate the outcomes of MitraClip in this population in a larger cohort.

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“…Finally, in a small series of cases recently published in end-stage HF patients previously excluded for HT due to PH, the use of MitraClip reduced PAP enough to redeem patients eligible for transplantation. This is of course an off-label indication of this device and further evidence is needed to confirm the potential benefit in this scenario 123 .…”

Section: Heart Diseasementioning

confidence: 93%

Novelties in Pulmonary Hypertension Secondary to Left Heart Disease

Rodríguez-Arias¹,

Solé‐González²,

García‐Álvarez³

2022

BRN

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Pulmonary hypertension due to left heart disease (PH-LHD) is the most common form of PH affecting approximately 1% of adults worldwide. Initially considered as just a passive consequence of increased pressure in the left chambers, new evidence shows the potential role of genetics, biological factors, or left atrial function. Along with the hemodynamic study, cardiac imaging techniques are essential to advance in the characterization of patients and select therapeutic strategies. Orphan of pharmacological treatments, new therapeutic targets are currently under investigation. The current review aims to review novelties in the fields of pathophysiology, diagnosis, and treatment in this entity.

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MitraClip procedure as ‘bridge to list’, the ultimate therapeutic option for end‐stage heart failure patients not eligible for heart transplantation due to severe pulmonary hypertension

Cited by 13 publications

References 8 publications

Haemodynamic impact of MitraClip in patients with functional mitral regurgitation and pulmonary hypertension

Haemodynamic impact of MitraClip in patients with functional mitral regurgitation and pulmonary hypertension

Transcatheter Mitral Valve Repair via MitraClip in Patients Aged <65 Years: Multicentre 2-year Outcomes

Novelties in Pulmonary Hypertension Secondary to Left Heart Disease

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