Why the study?
What are the long-term outcomes and predictors of survival in patients with severe biventricular heart failure and severe mitral regurgitation undergoing percutaneous edge-to-edge mitral valve repair?
Cohort (n=34)
Yes
What are the long-term outcomes and predictors of survival in patients with severe biventricular heart failure and severe mitral regurgitation undergoing percutaneous edge-to-edge mitral valve repair?
Absolute Event Rate: 77% vs 0%
p-value: p=0.0001
In patients with severe biventricular heart failure and severe MR undergoing pMVR, those with pulmonary hypertension and depressed RV function have very high 1-year mortality, whereas those with preserved RV function have favorable long-term outcomes.
May warrant caution for pMVR in patients with PH and depressed RV function; leaves open whether RV assessment should guide selection in severe biventricular HF.
OBJECTIVE: To assess long-term outcome and parameters associated with poor and favorable outcome in patients with a left ventricular ejection fraction (LV-EF) ≤25% and severe mitral regurgitation (MR) after percutaneous edge-to-edge mitral valve repair (pMVR). BACKGROUND: There is no data on long-term outcome in this cohort of patients. METHODS: We analyzed all 34 patients with a LV-EF ≤25% and severe MR treated with pMVR in 2 university hospitals from 2009 to 2012. RESULTS: Mitral regurgitation could be successfully reduced to grade ≤2 in 30 patients (88%). Long-term follow-up (up to 5 years) revealed a steep decline of the survival curve reaching 50% already 8 month after pMVR. In contrast, estimated survival of the remaining patients showed a favorable long-term outcome. Patients deceased during the first year presented with higher right ventricular tricuspid pressure gradient (RVTG) (44.5 ± 8.4 mmHg vs. 35.2 ± 15.4 mmHg, P = 0.035) and worse RV-function (P = 0.014) prior to the procedure. One-year mortality of patients with pulmonary hypertension and depressed RV-function (n = 22) was very high (77%) compared to the remaining patients (n = 12, mortality rate of 0%, P = 0.0001). CONCLUSIONS: Although pMVR lead to a successful reduction of MR in patients with a LV-EF ≤25%, 1-year mortality in this cohort was very high. However, a subgroup of patients showed a favorable long-term outcome after pMVR. Especially the right ventricular parameters sustained RV-function and absence of pulmonary hypertension-easily assessed with echocardiography-might be used to identify this subgroup and encourage pMVR in these patients.
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Orban et al. (2015) conducted a cohort in Severe biventricular heart failure and severe mitral regurgitation (n=34). Pulmonary hypertension and depressed RV-function vs. Absence of pulmonary hypertension and sustained RV-function was evaluated on 1-year mortality (p=0.0001).
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