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CoreValve, MitraClip outcomes promising in high-risk patients

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LOS ANGELES — A presentation at the American Association of Heart Failure Nurses Annual Conference has outlined favorable results from less-invasive therapies for high-risk patients with mitral regurgitation or aortic stenosis.

“Significant mitral regurgitation and severe aortic stenosis are often undertreated and contribute to HF, especially in the older patient population, meaning surgical mitral valve repair candidates and surgical aortic valve repair candidates are at increased periprocedural risk for morbidity and mortality,” said Eric Skipper, MD, FACS, medical director of adult cardiac surgery at Sanger Heart and Vascular Institute, Charlotte, N.C., during his presentation.

Skipper discussed two transcatheter devices, one for mitral valve repair (MitraClip, Abbott Vascular) and the other for aortic valve replacement (CoreValve, Medtronic). These devices are indicated for high-risk patients, such as those with degenerative mitral regurgitation, an STS mortality risk score of 8% or greater, extensive ascending aortic calcification, hostile chest, severe liver disease or liver failure, severe pulmonary hypertension and a positive frailty index score.

According to study results highlighted by Skipper, high-risk surgical patients treated with MitraClip demonstrated a reduction in length of hospital stay and in-hospital mortality, as well as improvements to ventricular remodeling, HF class and quality of life. He also noted that the procedure is cost effective, and that treatment with the device was not associated with increased mortality risk.

Patients who underwent transcatheter aortic valve replacement via CoreValve — also a cost-effective procedure, Skipper noted — experienced a reduction in 1-year mortality and repeat hospitalizations, with no increased stroke risk at 1 year compared with baseline. These patients also had an increased rate of paravalvular leak, but it was not associated with increased mortality, Skipper said.

For more information:

Skipper E. Evolving Management Strategies for Valvular Heart Disease. Presented at: the American Association of Heart Failure Nurses Annual Conference; June 26-28, 2014; Los Angeles.

Disclosure: Skipper is an institutional co-principal investigator for the Medtronic SURTAVI trial and an institutional investigator for the MitraClip COAPT study.