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J Am Coll Cardiol. 2014 Jul 15;64(2):182-92. doi: 10.1016/j.jacc.2013.10.021. Epub 2013 Oct 31.

Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair.

Author information

1
Division of Cardiology, University of Virginia, Charlottesville, Virginia. Electronic address: sl9pc@virginia.edu.
2
Harvard Clinical Research Institute, Boston, Massachusetts; Division of Cardiology, Lahey Clinic Medical Center, Burlington, Massachusetts.
3
Northshore University Health System, Chicago, Illinois.
4
Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
5
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
6
Duke University Medical Center, Durham, North Carolina.
7
Cleveland Clinic Foundation, Cleveland, Ohio.
8
Center for Interventional Vascular Therapy, Columbia University, New York, New York.
9
Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, Texas.

Abstract

BACKGROUND:

Surgical mitral valve repair (SMVR) remains the gold standard for severe degenerative mitral regurgitation (DMR). However, the results with transcatheter mitral valve repair (TMVR) in prohibitive-risk DMR patients have not been previously reported.

OBJECTIVES:

This study aimed to evaluate treatment of mitral regurgitation (MR) in patients with severe DMR at prohibitive surgical risk undergoing TMVR.

METHODS:

A prohibitive-risk DMR cohort was identified by a multidisciplinary heart team that retrospectively evaluated high-risk DMR patients enrolled in the EVEREST (Endovascular Valve Edge-to-Edge Repair Study) II studies.

RESULTS:

A total of 141 high-risk DMR patients were consecutively enrolled; 127 of these patients were retrospectively identified as meeting the definition of prohibitive risk and had 1-year follow-up (median: 1.47 years) available. Patients were elderly (mean age: 82.4 years), severely symptomatic (87% New York Heart Association class III/IV), and at prohibitive surgical risk (STS score: 13.2 ± 7.3%). TMVR (MitraClip) was successfully performed in 95.3%; hospital stay was 2.9 ± 3.1 days. Major adverse events at 30 days included death in 6.3%, myocardial infarction in 0.8%, and stroke in 2.4%. Through 1 year, there were a total of 30 deaths (23.6%), with no survival difference between patients discharged with MR ≤1+ or MR 2+. At 1 year, the majority of surviving patients (82.9%) remained MR ≤2+ at 1 year, and 86.9% were in New York Heart Association functional class I or II. Left ventricular end-diastolic volume decreased (from 125.1 ± 40.1 ml to 108.5 ± 37.9 ml; p < 0.0001 [n = 69 survivors with paired data]). SF-36 quality-of-life scores improved and hospitalizations for heart failure were reduced in patients whose MR was reduced.

CONCLUSIONS:

TMVR in prohibitive surgical risk patients is associated with safety and good clinical outcomes, including decreases in rehospitalization, functional improvements, and favorable ventricular remodeling, at 1 year. (Real World Expanded Multi-center Study of the MitraClip System [REALISM]; NCT01931956).

KEYWORDS:

mitral regurgitation; percutaneous; prohibitive surgical risk

PMID:
24184254
DOI:
10.1016/j.jacc.2013.10.021
[Indexed for MEDLINE]
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