Survival After MitraClip Treatment Compared to Surgical and Conservative Treatment for High-Surgical-Risk Patients With Mitral Regurgitation

Kortlandt, Friso; Velu, Juliëtte F.; Schurer, Remco A. J.; Hendriks, Tom; Branden, Ben Van den; Bouma, Berto J.; Feldman, Ted; Kelder, Johannes C.; Bakker, A.L.M.; Post, Marco C.; Harst, Pim van der; Eefting, Frank D.; Swaans, Martin J.; Rensing, Benno J.; Baan, Jan; Heyden, Jan Van der

doi:10.1161/circinterventions.117.005985

Cited by 25 publications

(13 citation statements)

References 24 publications

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“…Recently, the German TRAMI Registry reported an overall 4‐year observed survival after MitraClip of 46.9%, not significantly different between FMR and DMR ( P = 0.45) . Another large multicenter retrospective study showed a 5‐year survival after MitraClip for mixed MR mechanisms of 40% . Both were slightly lower than ours, likely explainable by their higher risk profile (respectively mean STS‐PROM 8.5% and 7.8%).…”

Section: Discussionmentioning

confidence: 80%

“…On the other hand, several large real‐world registries have reported promising early outcomes in patients at increased surgical risk who presented with mitral anatomies both within and outside the conventional EVEREST criteria, and as a matter of fact, the ability of EVEREST criteria to predict the long‐term results after the intervention is currently debated in the literature . Unfortunately, long‐term data from such wide cohorts are still scarce, especially when assessing FMR and DMR separately.…”

Section: Introductionmentioning

confidence: 99%

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Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Buzzatti

Denti

Scarfò

et al. 2018

Cathet Cardio Intervent

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Objectives To report mid‐term results after MitraClip repair, according to mitral regurgitation (MR) mechanism, in a real‐world single‐center experience. Background Mid‐term outcomes of percutaneous edge‐to‐edge mitral repair in the real world are still limited. Methods We assessed the follow‐up results of patients treated with MitraClip at a single high‐volume mitral center from 2008 to 2016. All patients underwent Heart‐Team discussion, prospective data collection and enrolment in a dedicated outpatient clinic. Functional (FMR, n = 242, 68.6%) and degenerative (DMR, n = 97, 27.5%) MR patients were separately analyzed. Results 5‐Year survival was 53.5 ± 4.5% in FMR vs 57.1 ± 7.5% in DMR (P = 0.087). Reduced survival was strongly associated with worse left ventricle remodeling (ESV HR 1.01, CI 1.01–1.02, P < 0.001) in FMR, and with worse symptoms (New York Heart Association IV HR 6.72, CI 1.78–25.45, P = 0.005) in DMR. 5‐Year cumulative incidence function for MR ≥ 3 was 23.7 ± 3.4% in FMR vs 27.9 ± 5.9% in DMR (P = 0.39), being associated with residual MR = 2 both in FMR (HR 4.67, CI 2.49–8.74, P < 0.001) and DMR (HR 7.15, CI 2.72–18.75, P < 0.001). At 5‐year, patients in NYHA class I‐II increased from 17.9% to 45.3% in FMR (P < 0.001) and from 33.3% to 51.3% in DMR (P < 0.001). Conclusions In this single‐center real‐world experience, 5‐year after MitraClip, half of the patients were alive and 3/4 were free from MR, both in FMR and DMR. Symptoms benefit was sustained in both groups. Advanced ventricular remodeling, advanced symptoms, and suboptimal MR reduction were associated with worse results. Refined patient selection, improved efficacy and more data will be all required to improve long‐term outcomes.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Buzzatti

Denti

Scarfò

et al. 2018

Cathet Cardio Intervent

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“…324 Due to their high surgical risk, such patients are now considered candidates for percutaneous repair or replacement of the aortic 325 and mitral valves. 326 In this scenario, CVR can be considered before the intervention, with the aim of decreasing complication rates, length of hospital stay, and mortality and morbidity associated with the frailty syndrome. 327 After the intervention, CVR then provides an opportunity for monitoring and optimization of the outcomes of the procedure in all its aspects.…”

Section: Pre-exercise Evaluationmentioning

confidence: 99%

Diretriz Brasileira de Reabilitação Cardiovascular – 2020

Carvalho¹,

Milani²,

Ferraz³

et al. 2020

Arquivos Brasileiros De Cardiologia

124

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“…After an initial screening, 14 reports [Niikura 2020;Alozie 2017;Kortlandt 2018;Feldman 2015;Paranskaya 2013;Anwer 2019;Swaans 2014;Taramasso 2012;De Bonis 2015;Buzzatti 2015;Gyoten 2020;Ondrus 2016;Buzzatti 2019;Ostovar 2018] comparing MitraClip with surgical MV repair, enrolling a total of 3355 patients with severe MR, were identified and included in qualitative and quantitative analyses. Only 1 study, the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) II10, was a randomized controlled trial, whereas the others were observational comparative studies (Table 1) [Niikura 2020;Alozie 2017;Kortlandt 2018;Paranskaya 2013;Anwer 2019;Swaans 2014;Taramasso 2012;De Bonis 2015;Buzzatti 2015;Gyoten 2020;Ondrus 2016;Buzzatti 2019;Ostovar 2018]. The late follow-up duration was from 180 days [Ostovar 2018] to 5 years [Feldman 2015] (Tables 1 and 2).…”

Section: Search Resultsmentioning

confidence: 99%

Comparison of Transcatheter Mitral-Valve Repair and Surgical Mitral-Valve Repair in Elderly Patients with Mitral Regurgitation

Yuan

Wei

et al. 2021

HSF

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Purpose: To summarize comparative studies of MitraClip versus surgical repair in typical, real-world elderly patients with severe mitral regurgitation (MR) and analyze the safety and effectiveness of these therapeutic options. Methods: PubMed, Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) were searched for comparative studies of transcatheter mitral-valve repair (TMVR) versus surgical mitral-valve repair (SMVR) in elderly patients with severe MR from January 2000 to June 2020. Statistical pooling for incidence estimates was performed according to a random-effects model with generic inverse-variance weighting, computing risk estimates with 95% confidence intervals (CIs), using RevMan 5.3. Results: A total of 14 reports comparing MitraClip with SMVR, enrolling 3355 patients with severe MR, were included in this study. Mean age, Logistic EuroSCORE, and incidence of diabetes mellitus (DM) were significantly higher in the MitraClip group, except the rate of patients with New York Heart Association (NYHA) class of >II and mean value of ejection fraction (EF). The arithmetic mean of freedom from acute mobility was similar. The 2 groups had equal all-cause mortality at 30 days, but different at 1 year (14% versus 9%) and 3 years in 7 studies (37% versus 25%). The freedom from recurrent MR ≥3+ was 88% and 97.3% at 30 days, 76.0% and 90.0% at 1 year, and 79% and 95% at 3 years in the MitraClip and surgical repair group, respectively. Conclusion: Although MitraClip is safe and effective in selected high-risk patients, the surgery may be the only gold standard for “gray” patients. Further studies are needed to determine whether MitraClip should be recommended.

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Survival After MitraClip Treatment Compared to Surgical and Conservative Treatment for High-Surgical-Risk Patients With Mitral Regurgitation

Abstract: This matched analysis suggests a lower mortality hazard for MitraClip intervention in a high-risk population with symptomatic mitral regurgitation when compared with conservative management alone.

Cited by 25 publications

References 24 publications

Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Diretriz Brasileira de Reabilitação Cardiovascular – 2020

Comparison of Transcatheter Mitral-Valve Repair and Surgical Mitral-Valve Repair in Elderly Patients with Mitral Regurgitation

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