Patient selection criteria and midterm clinical outcome for MitraClip therapy in patients with severe mitral regurgitation and severe congestive heart failure

Abstract

AimsThe implantation of a MitraClip (MC) is a new treatment modality for severe mitral regurgitation (MR) in patients whose condition is inoperable or who are at high conventional operative risk. This study reports the follow-up data of patients implanted with an MC in our heart centre to find selection criteria for this procedure in patients with severe congestive heart failure. Methods and resultsThis study included 163 implantation procedures in 157 patients between March 2009 and November 2012. The severe MR was caused by functional or organic valve disease. The patients had no surgical treatment option or dramatically increased surgical operative risk due to reduced LVEF or concomitant diseases. Three (2%) implantation procedures were unsuccessful. Eleven (7%) patients died during the first 30 days after MC implantation, and 9 (6%) additional patients died during the first 6 months, both groups mainly due to severe, therapy-resistant endstage heart failure. The 111 patients who were followed up showed significant improvement in NT-proBNP, LVEF, NYHA class, 6 min walk test, and quality of life. Ten (6%) patients needed conventional heart surgery despite high operative risk due to persistent symptomatic MR after MC implantation. ConclusionThe interventional implantation of an MC is a new treatment for severe MR with acceptable periprocedural risk and results in clinical improvement in the majority. Patients with end-stage heart failure and an NT-proBNP value .10 000 pg/mL have a high mortality despite MC implantation, and their treatment should be based on a very individualized decision. Based on this experience, a clinical algorithm for patient selection is proposed.--

Influence of non-cardiac comorbidities on outcome after percutaneous mitral valve repair: results from the German transcatheter mitral valve interventions (TRAMI) registry

“…Further, left ventricular reverse remodeling has been demonstrated [9,15,29]. In those and various other studies [8,16,18,27,28], high-risk patients were identified by STS and Euroscore which predominantly contain factors characterizing the underlying cardiac disease such as previous cardiac surgery, LVEF, concomitant coronary artery disease and operative risk. However, the influence of noncardiac comorbidities on outcome has not been systematically assessed, neither in observational studies nor in the EVEREST II trial.…”

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

“…18,23,24) Plasma NT-pro BNP level is commonly increased in patients undergoing MC implantation, and preceding studies demonstrated that a higher baseline natriuretic peptide level was strongly associated with worse long-term outcomes after MC. 12,25) MC is attracting clinical interest as a therapeutic option for not only severe MR but also HF. Therefore, we were interested in the response of the plasma NT-pro BNP level, which reflects the change of HF status after MC.…”

“…9) Previous studies have reported that BNP had predictive value for MR patients, 10,11) and we previously reported that increasing NT-pro BNP levels were associated with worse outcomes in patients undergoing MC. 12) Mitral valve surgery decreased the serum BNP levels of MR patients. [13][14][15] However, little is known about the response of NT-pro BNP levels after MC implantation; therefore, the determinants of the NT-pro BNP response after this procedure still remain unknown.…”

Mitral clip–looking back and moving forward

“…Several studies addressing this question have attempted to identify patients who will not derive benefit from MitraClip therapy. In Neuss and colleagues' [36] analysis of 157 patients with no surgical option or increased surgical risk because of poor left ventricular ejection fraction or comorbidities, mortality at 30 days after MitraClip was 7%, with 13% overall mortality at 6 months mainly because of severe, therapy-resistant endstage heart failure. Overall, 6% of patients needed surgery after MitraClip despite high operative risk because of persistent symptomatic mitral regurgitation.…”