Predictors of clinical outcomes after edge-to-edge percutaneous mitral valve repair

Capodanno, Davide; Adamo, Marianna; Barbanti, Marco; Giannini, Cristina; Laudisa, Maria Luisa; Cannata, Stefano; Curello, Salvatore; Immè, Sebastiano; Maffeo, Diego; Bedogni, Francesco; Petronio, Anna Sonia; Ettori, Federica; Tamburino, Corrado; Grasso, Carmelo

doi:10.1016/j.ahj.2015.04.010

Cited by 97 publications

(86 citation statements)

References 24 publications

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“…Because of heart failure and co‐morbidity, these end‐stage heart failure patients might finally not reach the goal of heart transplantation. A significant and frequent co‐morbidity in these patients is moderate–severe or severe mitral regurgitation because of mitral ring dilatation, termed as functional mitral regurgitation . Moderate–severe or severe mitral regurgitation leads to increases in pulmonary artery pressures, thus contributing to dyspnoea, exercise limitations, and mortality in end‐stage heart failure .…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair in patients with end‐stage heart failure awaiting heart transplantation

et al. 2018

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AimsFunctional mitral regurgitation is complicating end‐stage heart failure and potential heart transplantation by increasing pulmonary artery pressures. The aim of the present study was to investigate feasibility and haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair using the MitraClip™ device in patients with end‐stage heart failure awaiting heart transplantation.Methods and resultsIn this retrospective study, we identified nine patients suffering from end‐stage heart failure listed for heart transplantation in whom moderate–severe or severe functional mitral regurgitation was recognized and treated with percutaneous mitral valve edge‐to‐edge repair. Twenty‐two patients listed for heart transplantation and presenting with moderate–severe or severe functional mitral regurgitation treated in the pre‐MitraClip™ era served as controls. Patients were analysed at two separate time points: MitraClip™ group: pre‐procedure and post‐procedure (follow‐up: 215 ± 53 days) and control group: study entry with recognition of moderate–severe or severe functional mitral regurgitation (follow‐up: 197 ± 47 days). Percutaneous mitral valve edge‐to‐edge repair with the MitraClip™ was feasible and safe in our high‐risk end‐stage heart failure population. The intervention resulted in significant reduction of mitral regurgitation (grade 3.0 [0.5] to 1.5 [0.5]; P = 0.009), left atrial diameter (51 mm [16] to 49 mm [4]; follow‐up MitraClip™ vs. control group P = 0.0497), pulmonary artery pressures (sPA 50 mmHg [15] to 45 mmHg [10]; P = 0.02; mPA 34 mmHg [8] to 30 mmHg [10]; P = 0.02), and New York Heart Association class (3.5 [1.0] to 3.0 [0.5]; P = 0.01) and improved mixed‐venous oxygen saturation (57% [11] to 55% [7]; follow‐up MitraClip™ vs. control group P = 0.02). No changes in the control group were observed.ConclusionsMitraClip™ implantation as ‘bridge‐to‐transplant’ strategy in patients with end‐stage heart failure and severe functional mitral regurgitation awaiting heart transplantation is feasible and appears to result in favourable haemodynamic effects.

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Section: Discussionmentioning

confidence: 99%

Haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair in patients with end‐stage heart failure awaiting heart transplantation

et al. 2018

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“…26 These findings suggest that an ischaemic setting potentially represents a more challenging scenario for percutaneous treatment of MR, stressing the importance of patient selection. Our results are consistent with the data reported by Capodanno et al showing a significant worsening in terms of re-hospitalization in patients presenting with an ischaemic aetiology at 2 years' follow-up.…”

Section: Discussionmentioning

confidence: 97%

“…26 However, this study presents several limitations because it included a wide spectrum of high-risk patients with both functional and degenerative MR. These finding are in contrast with those of a previous study that reported an increased risk of all-cause death after MitraClip in patients presenting an ischaemic aetiology or those with severely dilated left ventricle.…”

Section: Discussionmentioning

confidence: 98%

A meta‐analysis of MitraClip combined with medical therapy vs. medical therapy alone for treatment of mitral regurgitation in heart failure patients

et al. 2018

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“…In recent years, some registry studies[4-6] and several smaller studies[7-11] concerning MitraClip ® have been published. However, relatively little is known about the long-term results of percutaneous mitral valve repair.…”

Section: Introductionmentioning

confidence: 99%

One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation

Gotzmann

Sprenger

Ewers

et al. 2017

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AIMTo investigate one-year outcomes after percutaneous mitral valve repair with MitraClip® in patients with severe mitral regurgitation (MR).METHODSOur study investigated consecutive patients with symptomatic severe MR who underwent MitraClip® implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTSThe study population consisted of 46 consecutive patients (mean logistic EuroSCORE 32% ± 21%). The degree of MR decreased significantly (severe MR before MitraClip® 100% vs after MitraClip® 13%; P < 0.001), and the NYHA functional classes improved (NYHA III/IV before MitraClip® 98% vs after MitraClip® 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%, respectively. During the follow-up of 473 ± 274 d, 11 patients died (90% due to cardiovascular death). A pre-procedural plasma B-type natriuretic peptide level > 817 pg/mL was associated with all-cause mortality (hazard ratio, 6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSIONPercutaneous mitral valve repair with MitraClip® has positive effects on hemodynamics and symptoms. Despite the study patients’ multiple comorbidities and extremely high operative risk, one-year outcomes after MitraClip® are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.

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Predictors of clinical outcomes after edge-to-edge percutaneous mitral valve repair

Cited by 97 publications

References 24 publications

Haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair in patients with end‐stage heart failure awaiting heart transplantation

Haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair in patients with end‐stage heart failure awaiting heart transplantation

A meta‐analysis of MitraClip combined with medical therapy vs. medical therapy alone for treatment of mitral regurgitation in heart failure patients

One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation

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