Key result
Percutaneous mitral valve edge-to-edge repair using MitraClip significantly reduced mitral regurgitation grade (from 3.0 to 1.5; P=0.009) and systolic pulmonary artery pressures (P=0.02).
Why the study?
Does percutaneous mitral valve edge-to-edge repair improve haemodynamic parameters in patients with end-stage heart failure awaiting heart transplantation?
Cohort (n=31)
Does percutaneous mitral valve edge-to-edge repair improve haemodynamic parameters in patients with end-stage heart failure awaiting heart transplantation?
p-value: p=0.009
Percutaneous mitral valve edge-to-edge repair is a feasible bridge-to-transplant strategy that significantly improves haemodynamics and reduces pulmonary artery pressures in patients with end-stage heart failure and severe functional mitral regurgitation.
Hypothesis-generating for MitraClip in end-stage HF pre-transplant; prospective trials needed before clinical adoption.
AIMS: Functional mitral regurgitation is complicating end-stage heart failure and potential heart transplantation by increasing pulmonary artery pressures. The aim of the present study was to investigate feasibility and haemodynamic effects of percutaneous mitral valve edge-to-edge repair using the MitraClip™ device in patients with end-stage heart failure awaiting heart transplantation. METHODS AND RESULTS: In this retrospective study, we identified nine patients suffering from end-stage heart failure listed for heart transplantation in whom moderate-severe or severe functional mitral regurgitation was recognized and treated with percutaneous mitral valve edge-to-edge repair. Twenty-two patients listed for heart transplantation and presenting with moderate-severe or severe functional mitral regurgitation treated in the pre-MitraClip™ era served as controls. Patients were analysed at two separate time points: MitraClip™ group: pre-procedure and post-procedure (follow-up: 215 ± 53 days) and control group: study entry with recognition of moderate-severe or severe functional mitral regurgitation (follow-up: 197 ± 47 days). Percutaneous mitral valve edge-to-edge repair with the MitraClip™ was feasible and safe in our high-risk end-stage heart failure population. The intervention resulted in significant reduction of mitral regurgitation (grade 3.0 [0.5] to 1.5 [0.5]; P = 0.009), left atrial diameter (51 mm [16] to 49 mm [4]; follow-up MitraClip™ vs. control group P = 0.0497), pulmonary artery pressures (sPA 50 mmHg [15] to 45 mmHg [10]; P = 0.02; mPA 34 mmHg [8] to 30 mmHg [10]; P = 0.02), and New York Heart Association class (3.5 [1.0] to 3.0 [0.5]; P = 0.01) and improved mixed-venous oxygen saturation (57% [11] to 55% [7]; follow-up MitraClip™ vs. control group P = 0.02). No changes in the control group were observed. CONCLUSIONS: MitraClip™ implantation as 'bridge-to-transplant' strategy in patients with end-stage heart failure and severe functional mitral regurgitation awaiting heart transplantation is feasible and appears to result in favourable haemodynamic effects.
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Geis et al. (2018) conducted a cohort in End-stage heart failure with functional mitral regurgitation (n=31). Percutaneous mitral valve edge-to-edge repair using the MitraClip™ device vs. Historical controls treated in the pre-MitraClip™ era was evaluated on Mitral regurgitation grade (p=0.009). Percutaneous mitral valve edge-to-edge repair using MitraClip significantly reduced mitral regurgitation grade (from 3.0 to 1.5; P=0.009) and systolic pulmonary artery pressures (P=0.02).
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