Percutaneous Edge-to-Edge Mitral Valve Repair for Functional Mitral Regurgitation in a High-Surgical-Risk Patient

2012 ◽  
pp. 533-538
Author(s):  
Dominique Himbert ◽  
Eric Brochet ◽  
David Messika-Zeitoun ◽  
Gregory Ducrocq ◽  
Jean Michel Juliard ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Risk Patient ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Surgical Risk ◽  
High Surgical Risk

scholarly journals Residual mitral regurgitation impact on outcomes after mitraclip therapy: five-year follow-up from the GRASP registry

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
AM Caggegi ◽  
P Capranzano ◽  
S Scandura ◽  
S Mangiafico ◽  
G Castania ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
Valve Repair ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Mitraclip Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background – Although percutaneous mitral valve repair is an attractive alternative treatment option for patients with severe mitral regurgitation (MR) at high surgical risk, residual MR is commonly observed after the procedure and little is known about its impact on outcomes after MitraClip therapy, expecially in patients with severe left ventricular (LV) impairment. Purpose – The aim of this prospective, observational study was to evaluate the impact of residual MR (MR ≤1+ vs. MR >1+) on long-term outcomes of mitral valve repair with the MitraClip System in high surgical risk patients presenting with moderate-to-severe or severe MR and with severe reduction of LV ejection fraction (EF). Methods – Patients enrolled in the prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) with functional MR and EF ≤30% who were eligible at almost five-year follow-up were included in the present analysis.  The primary endpoint was death at 5-year follow-up.  Also echocardiographic parameters at baseline and 5-year follow-up and rehospitalization rates were assessed. Results – A total of 139 patients were included: 92 (66.2%) with post-procedural residual MR ≤1+ and 47 (33.8%) with residual MR > 1+ (41 patients with residual MR 2+, 5 with residual MR 3+, 1 with residual MR 4+).  Comparable clinical and echocardiographic baseline characteristics were observed between the two groups except for NYHA functional class IV and implanted pace-maker (more frequent in patients with residual MR >1+) and previous myocardial infarction (more frequent  in patients with residual MR ≤1+). At 5-year follow-up, no significant differences were reported in the primary endpoint (49.6% in patients with residual MR ≤ 1+ vs. 65.3% in patients with residual MR > 1+, p 0.203) and in cardiac death (37.8% in patients with residual MR ≤ 1+ vs. 42.6% in patients with residual MR > 1+, p 0.921). Cox regression analysis identified residual MR > 1+ as an independent predictor of re-hospitalization (HR 0.51, 95% CI 0.28-0.92, p =0.026). At 5-year follow-up,  a significant reduction in left ventricular end-systolic volume was  observed in patients with residual MR ≤ 1+. Conclusions – At 5-year follow no significant differences in survival emerged in patients with severe  LV dysfunction undergoing MitraClip therapy regardless residual MR. Nevertheless residual MR > 1+ emerged as an indipendent predictor of re-hospitalization.

Abstract 10998: Estimated Surgical Risk and Anatomical Compatibility for MitraClip Intervention in Patients With Severe Mitral Regurgitation According to Valve Disease Etiology

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yoram Agmon ◽  
Itai Gofman
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Bypass Surgery ◽  
Risk Scores ◽  
Clinical Indication ◽  
Valve Repair ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Clinical Records

Background: Percutaneous mitral valve repair using the MitraClip technology was originally introduced to treat degenerative (myxomatous) mitral regurgitation (DMR), but it is currently mostly used in patients (pts) with functional (ischemic) MR (FMR). We examined whether this approach was justified, based on surgical risk and valve anatomy. Methods: Consecutive pts with severe MR who were hospitalized at a tertiary care medical center were identified and their clinical records and echocardiographic studies were reviewed. Surgical risk was estimated using the Society of Thoracic Surgeons (STS) risk scores. The anatomical compatibility for MitraClip invervention was assessed using the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) echocardiographic criteria. Results: Of 236 pts included in the study during 3 yrs, the cause of MR was FMR in 104 pts (44.1%), DMR in 84 (35.6%), and other causes (mainly endocarditis and rheumatic disease) in 48 (20.3%). Age and gender distribution were similar in pts with FMR (age 71±14 years, 62.5% male) and DMR (age 73±14 years, 66.7% male) and severe NYHA III/IV heart failure symptoms justifying intervention were evident in 73.1% and 60.7% of pts, respectively (P=0.10). Using multiple risk scores, the estimated surgical risk (mortality and major morbidity) for mitral valve repair or replacement (with or without bypass surgery) was consistently much higher in pts with FMR than DMR. Valve anatomy was suitable for MitraClip intervention in 87 pts (83.7%) with FMR versus only 38 pts (45.2%) with DMR (P<0.001). Assuming the most common type of surgery was valve repair for DMR and annuloplasty + bypass surgery for FMR, and using an STS estimated mortality greater than 10% to define high surgical risk, only 6 pts with DMR (7.1%) had a clinical indication for intervention, high surgical risk, and valve anatomy suitable for MitraClip intervention, versus 21 pts (20.2%) with FMR (P<0.001). Using an STS estimated mortality and morbidity greater than 20% to define high surgical risk, these proportions were 20 pts (23.8%) for DMR and 60 pts (57.7%) for FMR (P<0.001). Conclusion: Higher surgical risk and better anatomical compatibility justify the greater use of MitraClip intervention in patients with FMR than in patients with DMR.

scholarly journals TCT-787 Effectiveness of Transcatheter Mitral Valve Repair in Degenerative Mitral Regurgitation in High Surgical Risk Patients

2012 ◽  
Vol 60 (17) ◽  
pp. B229
Author(s):  
D. Scott Lim ◽  
Saibal Kar ◽  
Patrick Whitlow ◽  
Michael Argenziano ◽  
Alfredo Trento ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Surgical Risk ◽  
Transcatheter Mitral Valve Repair ◽  
High Surgical Risk ◽  
Risk Patients

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

2020 ◽  
Vol 21 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Tomás Benito-González ◽  
Rodrigo Estévez-Loureiro ◽  
Pedro A. Villablanca ◽  
Patrizio Armeni ◽  
Ignacio Iglesias-Gárriz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair
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