October 1, 2014
View Full PaperClinical outcomes of MitraClip for the treatment of functional mitral regurgitation
Structured PICO
Does MitraClip implantation improve clinical outcomes and reduce mitral regurgitation in inoperable or high-risk surgical candidates with functional mitral regurgitation?
P
Population
109 consecutive inoperable or high-risk surgical candidates with functional mitral regurgitation (FMR), mean age 69±9 years, 82% NYHA Class III-IV.
I
Intervention
MitraClip implantation
O
Outcome
Medium-term outcomes including procedural success, 30-day mortality, MR reduction, and survival
MitraClip implantation is a safe and effective alternative to surgery for high-risk patients with functional mitral regurgitation, providing sustained MR reduction and acceptable medium-term survival.
Abstract
AIMS: The aim of this study was to report medium-term outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with functional mitral regurgitation (FMR) in our single-centre experience. From October 2008, 109 consecutive patients with FMR underwent MitraClip implantation (mean age 69±9 years; 82% NYHA Class III-IV). Logistic EuroSCORE was 22±16%. Comorbidities included: chronic renal failure (47%), diabetes (22%), COPD (28%). Mean EF was 28±11%; LVEDD was 68±8 mm. Procedural success was 99% and 30-day mortality was 1.8%. At discharge, 87% patients had MR ≤2+. At 12 months, EF was 34.7±10.4% (p=0.002 compared to preoperative value). Actuarial survival at three years was 74.5±7%. Actuarial freedom from MR ≥3+ at 2.5 years was 70±6%. At one-year follow-up, 86% of patients were in NYHA Class I-II. Preoperative pro-BNP level ≥1,600 pg/ml was identified as an independent risk factor of mortality at follow-up. MitraClip therapy for FMR is a valuable alternative to surgery in high-risk patients. Higher preoperative pro-BNP level is a risk factor for mortality at follow-up. Although patients treated in current practice are high-risk, the procedure remains safe and effective in selected patients.