Purpose: The aim of the present study was to investigate the predictors of mortality of percutaneous mitral valve repair (PMVR) using the MitraClip System in patients affected by severe MR (mitral regurgitation) with end-stage heart failure and severely reduced left ventricular ejection fraction (LV-EF). Methods: Between October 2008 and October 2013, 304 consecutive patients undergoing PMVR at 4 Italian centers were prospectively enrolled in a registry. To the purpose of our study, we analyzed the 88 patients with functional MR and LV-EF<30% who reached 1 year follow-up. Results: Mean age was 70±10 years, 71.6% were male, with a mean EuroSCORE II of 9.8±4.5%. Patients with MR grade ≥3+ were 5.7% and 11.4% at discharge and 1 year, respectively, versus 100% at baseline (p<0.0001), with a marked clinical benefit (NYHA class ≥3 at 1 year 9.0%, vs. 86.3% at baseline; p<0.0001). One year all-cause mortality was 21.6%. Baseline factors associated with 1 year mortality at univariate analysis were lower haemoglobin values (12.2±1.6 vs 11.4±1.6 g/dl; p=0.04), higher creatinine values (1.35±0.95 vs 1.67±0.67 mg/dl; p=0.01), lower glomerular filtration rate values (65.1±29.2 vs 54.3±33.1 ml/min/1.73m2; p=0.03), presence of chronic renal failure (8.9 vs 36.6%; p=0.002), higher EuroSCORE II and STS score values (8.0±6.3 vs 12.9±10.2%; p=0.02 and 6.2±5.8 vs 9.9±8.4%; p=0.05; respectively), lack of implantable cardiac defibrillator with resichronization therapy (ICD-CRT) (27.6 vs 10%; p=0.05) and NYHA class 4 (41.2 vs 16.9%; p=0.03). At Cox proportional hazards analysis, chronic renal failure (p=0.029; OR 4.0; 95%CI 1.2-14.2), lack of CRT-ICD (p=0.021; OR 0.22; 95%CI 0.06-0.80), and NYHA class 4 (p=0.047; OR 9.3; 95%CI 1.03-83.4) were independent predictors of 1 year mortality. Lower haemoglobin values almost reached statistical significance (p=0.06; OR 0.72; 95%CI 0.0.51-1.01) Conclusion: MitraClip procedure reduces functional MR and improves NYHA class even in end-stage heart failure patients. However, among these critically ill patients, the 1-year mortality is still prohibitive in case of renal failure, NYHA class IV, or anaemia, while the presence of ICD-CRT appears protective.

MitraClip implantation in patients with end-stage systolic heart failure

M. De Carlo;PETRONIO, ANNA;
2014-01-01

Abstract

Purpose: The aim of the present study was to investigate the predictors of mortality of percutaneous mitral valve repair (PMVR) using the MitraClip System in patients affected by severe MR (mitral regurgitation) with end-stage heart failure and severely reduced left ventricular ejection fraction (LV-EF). Methods: Between October 2008 and October 2013, 304 consecutive patients undergoing PMVR at 4 Italian centers were prospectively enrolled in a registry. To the purpose of our study, we analyzed the 88 patients with functional MR and LV-EF<30% who reached 1 year follow-up. Results: Mean age was 70±10 years, 71.6% were male, with a mean EuroSCORE II of 9.8±4.5%. Patients with MR grade ≥3+ were 5.7% and 11.4% at discharge and 1 year, respectively, versus 100% at baseline (p<0.0001), with a marked clinical benefit (NYHA class ≥3 at 1 year 9.0%, vs. 86.3% at baseline; p<0.0001). One year all-cause mortality was 21.6%. Baseline factors associated with 1 year mortality at univariate analysis were lower haemoglobin values (12.2±1.6 vs 11.4±1.6 g/dl; p=0.04), higher creatinine values (1.35±0.95 vs 1.67±0.67 mg/dl; p=0.01), lower glomerular filtration rate values (65.1±29.2 vs 54.3±33.1 ml/min/1.73m2; p=0.03), presence of chronic renal failure (8.9 vs 36.6%; p=0.002), higher EuroSCORE II and STS score values (8.0±6.3 vs 12.9±10.2%; p=0.02 and 6.2±5.8 vs 9.9±8.4%; p=0.05; respectively), lack of implantable cardiac defibrillator with resichronization therapy (ICD-CRT) (27.6 vs 10%; p=0.05) and NYHA class 4 (41.2 vs 16.9%; p=0.03). At Cox proportional hazards analysis, chronic renal failure (p=0.029; OR 4.0; 95%CI 1.2-14.2), lack of CRT-ICD (p=0.021; OR 0.22; 95%CI 0.06-0.80), and NYHA class 4 (p=0.047; OR 9.3; 95%CI 1.03-83.4) were independent predictors of 1 year mortality. Lower haemoglobin values almost reached statistical significance (p=0.06; OR 0.72; 95%CI 0.0.51-1.01) Conclusion: MitraClip procedure reduces functional MR and improves NYHA class even in end-stage heart failure patients. However, among these critically ill patients, the 1-year mortality is still prohibitive in case of renal failure, NYHA class IV, or anaemia, while the presence of ICD-CRT appears protective.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/812954
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