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Findings identify factors linked to survival after MitraClip procedure
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The results from a multicenter, longitudinal study have found that procedural success, residual mitral regurgitation discharge grade and in-hospital congestive HF are important predictors of midterm survival after use of the MitraClip device for percutaneous mitral valve repair.
Researchers of the study, published in Heart, enrolled the first 100 consecutive patients treated with the MitraClip system (Abbott Vascular) for percutaneous mitral valve repair performed under echocardiographic and fluoroscopic guidance in general anesthesia in Switzerland between March 2009 and April 2011.
All patients had moderate-to-severe (3+) or severe (4+) mitral regurgitation of functional (62%) or degenerative (38%) origin. Most patients were in functional class NYHA III or IV (82%) or had a recent history of decompensated HF. Mean left ventricular ejection fraction was 48% and the median European System for Cardiac Operative Risk Evaluation was 16.9%.
Eighty-five percent of patients achieved acute procedural success, defined as successful clip implantation with residual mitral regurgitation grade ≤2+. Overall survival at 6 months was 89.9% (95% CI, 81.8-94.6), and at 12 months it was 84.6% (95% CI, 74.7-91).
Predictors for improvement of pulmonary artery pressure were acute procedural success (P=.0017) and low mitral regurgitation grade at discharge (P=.0078; for MR >2+, P=.0024). Congestive HF before the procedure (P=.04) and prior CABG (P=.008) predicted mortality. In-hospital mortality was 4%.
Researchers said acute procedural success — defined as a reduction in mitral regurgitation to 2+ or less during the procedure — along with the severity of residual mitral regurgitation at discharge and in-hospital congestive HF predicted midterm outcomes.
“This emphasizes the importance of obtaining an optimal result and a pre-discharge echocardiography to predict the prognosis of the patient after [mitral valve repair],” they wrote.
Disclosure: Sürder reported no relevant financial disclosures.
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