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Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

BACKGROUND: The MitraClip procedure was established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, the aim was to evaluate 5-year outcomes after MitraClip. METHODS: Consecutive patients...

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Autores principales: Öztürk, Can, Friederich, Mona, Werner, Nikos, Nickenig, Georg, Hammerstingl, Christoph, Schueler, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Via Medica 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078937/
https://www.ncbi.nlm.nih.gov/pubmed/31313274
http://dx.doi.org/10.5603/CJ.a2019.0071
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author Öztürk, Can
Friederich, Mona
Werner, Nikos
Nickenig, Georg
Hammerstingl, Christoph
Schueler, Robert
author_facet Öztürk, Can
Friederich, Mona
Werner, Nikos
Nickenig, Georg
Hammerstingl, Christoph
Schueler, Robert
author_sort Öztürk, Can
collection PubMed
description BACKGROUND: The MitraClip procedure was established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, the aim was to evaluate 5-year outcomes after MitraClip. METHODS: Consecutive patients undergoing the MitraClip system were prospectively included. All patients underwent clinical follow-up and transthoracic echocardiography. RESULTS: Two hundred sixty-five patients (age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60.5% secondary MR [sMR]). Although high procedural success of 91.3% was found, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04). Five years after the MitraClip procedure, the majority of patients presented with reduced symptoms and improved functional capacity (functional NYHA class: p = 0.0001; 6 minutes walking test: p = 0.04). Sustained MR reduction (≤ grade 2) was found in 74% of patients, and right ventricular (RV) function was significantly increased (p = 0.03). Systolic pulmonary artery pressure (sPAP) was significantly reduced during follow-up only in sMR patients (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, 5-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (MVG) (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality. CONCLUSIONS: Transcatheter mitral valve repair with the MitraClip system showed low complication rates and sustained MR reduction with improved RV function and sPAP 5 years after the procedure was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher 5-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and 5-year mortality.
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spelling pubmed-80789372021-05-10 Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve Öztürk, Can Friederich, Mona Werner, Nikos Nickenig, Georg Hammerstingl, Christoph Schueler, Robert Cardiol J Interventional Cardiology BACKGROUND: The MitraClip procedure was established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, the aim was to evaluate 5-year outcomes after MitraClip. METHODS: Consecutive patients undergoing the MitraClip system were prospectively included. All patients underwent clinical follow-up and transthoracic echocardiography. RESULTS: Two hundred sixty-five patients (age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60.5% secondary MR [sMR]). Although high procedural success of 91.3% was found, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04). Five years after the MitraClip procedure, the majority of patients presented with reduced symptoms and improved functional capacity (functional NYHA class: p = 0.0001; 6 minutes walking test: p = 0.04). Sustained MR reduction (≤ grade 2) was found in 74% of patients, and right ventricular (RV) function was significantly increased (p = 0.03). Systolic pulmonary artery pressure (sPAP) was significantly reduced during follow-up only in sMR patients (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, 5-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (MVG) (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality. CONCLUSIONS: Transcatheter mitral valve repair with the MitraClip system showed low complication rates and sustained MR reduction with improved RV function and sPAP 5 years after the procedure was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher 5-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and 5-year mortality. Via Medica 2021-04-13 /pmc/articles/PMC8078937/ /pubmed/31313274 http://dx.doi.org/10.5603/CJ.a2019.0071 Text en Copyright © 2021 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
spellingShingle Interventional Cardiology
Öztürk, Can
Friederich, Mona
Werner, Nikos
Nickenig, Georg
Hammerstingl, Christoph
Schueler, Robert
Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
title Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
title_full Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
title_fullStr Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
title_full_unstemmed Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
title_short Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
title_sort single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
topic Interventional Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078937/
https://www.ncbi.nlm.nih.gov/pubmed/31313274
http://dx.doi.org/10.5603/CJ.a2019.0071
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