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

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.

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Impact of etiology of mitral regurgitation (MR) on results after interventional mitral valve repair using the MitraClip system in high-surgical-risk patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297620 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

J Schirmer ◽

S Baldus ◽

H Treede ◽

V Rudolph ◽

O Franzen ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Valve Repair ◽

Surgical Risk ◽

High Surgical Risk ◽

Risk Patients ◽

Mitraclip System

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.220 ◽

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.

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