Why the study?
Symptomatic medical therapy remains weak in controlling severe MR with high morbidity and mortality in elderly patients, and high surgical-risk patients seem to benefit from MitraClip.
Does transcatheter mitral valve repair using MitraClip safely reduce mitral regurgitation and improve symptoms in patients older than 80 years with severe symptomatic mitral regurgitation and high surgical risk?
Does transcatheter mitral valve repair using MitraClip safely reduce mitral regurgitation and improve symptoms in patients older than 80 years with severe symptomatic mitral regurgitation and high surgical risk?
Transcatheter mitral valve repair is a safe and effective treatment option for severe symptomatic mitral regurgitation in octogenarians with high surgical risk, yielding high procedural success and 1-year survival.
Supports MitraClip safety in high-risk elderly with severe MR; hypothesis-generating and requires randomized confirmation before practice change.
Background and objectives Symptomatic mitral regurgitation (MR) is associated with a high mortality rate and high heart failure-related hospitalization. Symptomatic therapy in the elderly and very elderly patients remains weak in controlling severe MR with an elevated morbidity and mortality rate. Patients with an increased risk of surgical repair of the MR seemed to benefit from MitraClip procedures. Therefore, we thought to analyze the postprocedural safety and success of the MitraClip in octogenarians and older patients. Methods Elderly and very elderly patients with severe and symptomatic MR were presented and evaluated in the heart team. Patients with high surgical risks underwent MitraClip (Abbot, USA) procedure in our center. Post-procedural transthoracic echocardiography (TTE) procedure was performed to determine the MR grade and exclude procedure-related complications. Results Two hundred eleven consecutive patients, older than 80 years (83.75±2.95, 106 Men (83.5±3.06) and 105 Women (84.01±2.83)), who received MitraClip between May 2015 and May 2020 were enrolled. The baseline characteristics are presented in table 1. Procedural success, defined as reducing the MR to grad I-II, was achieved in 93% of the patients (3.11±0.34 vs. 1.25±0.46, P=0.002). All patients improved in the New York Heart Association functional class (3.04±0.40 vs. 1.92±0.76) one year after the intervention. No procedure-related death was registered. 81% (n=168) survival rate was achieved one year after the intervention. No clip embolization was detected in 3 months echocardiography control, Table 2. Conclusions Our preliminary results indicate that MitraClip is a safe and effective therapeutic option in elderly and very elderly patients with severe MR and high surgical risks. Therefore, this therapy should be considered despite age and comorbidities for effective symptomatic treatment in this particular cohort. Funding Acknowledgement Type of funding sources: None.
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Mahnkopf et al. (2022) studied this question.
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