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Predictors for efficacy of percutaneous mitral valve repair using the MitraClip system: the results of the MitraSwiss registry


Abstract

BACKGROUND:
Percutaneous mitral valve repair (MVR) using the MitraClip system has become a valid alternative for patients with severe mitral regurgitation (MR) and high operative risk.
OBJECTIVE:
To identify clinical and periprocedural factors that may have an impact on clinical outcome.
DESIGN:
Multi-centre longitudinal cohort study.
SETTING:
Tertiary referral centres.
PATIENTS:
Here we report on the first 100 consecutive patients treated with percutaneous MVR in Switzerland between March 2009 and April 2011. All of them had moderate-severe (3+) or severe (4+) MR, and 62% had functional MR. 82% of the patients were in New York Heart Association (NYHA) class III/IV, mean left ventricular ejection fraction was 48% and the median European System for Cardiac Operative Risk Evaluation was 16.9%.
INTERVENTIONS:
MitraClip implantation performed under echocardiographic and fluoroscopic guidance in general anaesthesia.
MAIN OUTCOME MEASURES:
Clinical, echocardiographic and procedural data were prospectively collected.
RESULTS:
Acute procedural success (APS, defined as successful clip implantation with residual MR grade ≤2+) was achieved in 85% of patients. Overall survival at 6 and 12 months was 89.9% (95% CI 81.8 to 94.6) and 84.6% (95% CI 74.7 to 91.0), respectively. Univariate Cox regression analysis identified APS (p=0.0069) and discharge MR grade (p=0.03) as significant predictors of survival.
CONCLUSIONS:
In our consecutive cohort of patients, APS was achieved in 85%. APS and residual discharge MR grade are important predictors of mid-term survival after percutaneous MVR.

BACKGROUND:
Percutaneous mitral valve repair (MVR) using the MitraClip system has become a valid alternative for patients with severe mitral regurgitation (MR) and high operative risk.
OBJECTIVE:
To identify clinical and periprocedural factors that may have an impact on clinical outcome.
DESIGN:
Multi-centre longitudinal cohort study.
SETTING:
Tertiary referral centres.
PATIENTS:
Here we report on the first 100 consecutive patients treated with percutaneous MVR in Switzerland between March 2009 and April 2011. All of them had moderate-severe (3+) or severe (4+) MR, and 62% had functional MR. 82% of the patients were in New York Heart Association (NYHA) class III/IV, mean left ventricular ejection fraction was 48% and the median European System for Cardiac Operative Risk Evaluation was 16.9%.
INTERVENTIONS:
MitraClip implantation performed under echocardiographic and fluoroscopic guidance in general anaesthesia.
MAIN OUTCOME MEASURES:
Clinical, echocardiographic and procedural data were prospectively collected.
RESULTS:
Acute procedural success (APS, defined as successful clip implantation with residual MR grade ≤2+) was achieved in 85% of patients. Overall survival at 6 and 12 months was 89.9% (95% CI 81.8 to 94.6) and 84.6% (95% CI 74.7 to 91.0), respectively. Univariate Cox regression analysis identified APS (p=0.0069) and discharge MR grade (p=0.03) as significant predictors of survival.
CONCLUSIONS:
In our consecutive cohort of patients, APS was achieved in 85%. APS and residual discharge MR grade are important predictors of mid-term survival after percutaneous MVR.

Citations

52 citations in Web of Science®
63 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:25 Mar 2013 09:06
Last Modified:05 Apr 2016 16:26
Publisher:BMJ Publishing Group
ISSN:1355-6037
Publisher DOI:https://doi.org/10.1136/heartjnl-2012-303105
PubMed ID:23343688
Permanent URL: https://doi.org/10.5167/uzh-72597

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