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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
Author(s) -
Buzzatti Nicola,
Denti Paolo,
Scarfò Iside Stella,
Giambuzzi Ilaria,
Schiavi Davide,
Ruggeri Stefania,
Castiglioni Alessandro,
De Bonis Michele,
La Canna Giovanni,
Alfieri Ottavio
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28029
Subject(s) - medicine , mitraclip , mitral regurgitation , ventricle , ejection fraction , cardiology , single center , prospective cohort study , percutaneous , heart failure , surgery
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.