Safety and efficacy of MitraClipTM therapy in patients with severely impaired left ventricular ejection fraction

• Verfasst von: Geis, Nicolas [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Bekeredjian, Raffi [VerfasserIn]
• Titel: Safety and efficacy of MitraClipTM therapy in patients with severely impaired left ventricular ejection fraction
• Titelzusatz: results from the German transcatheter mitral valve interventions (TRAMI) registry
• Verf.angabe: Nicolas A. Geis, Miriam Puls, Edith Lubos, Christine S. Zuern, Jennifer Franke, Robert Schueler, Ralph S. von Bardeleben, Peter Boekstegers, Taoufik Ouarrak, Ralf Zahn, Hüseyin Ince, Jochen Senges, Hugo A. Katus and Raffi Bekeredjian
• Jahr: 2018
• Jahr des Originals: 2017
• Umfang: 11 S.
• Fussnoten: Im Titel ist "TM" hochgestellt ; Online publish-ahead-of-print: 18 August 2017 ; Gesehen am 27.04.2018
• Titel Quelle: Enthalten in: European journal of heart failure
• Ort Quelle: Oxford : Wiley, 1999
• Jahr Quelle: 2018
• Band/Heft Quelle: 20(2018), 3, Seite 598-608
• ISSN Quelle: 1879-0844
• DOI: doi:10.1002/ejhf.910
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Outcome
• Sach-SW: Heart failure
• Sach-SW: MitraClip™
• Sach-SW: Mitral regurgitation
• Sach-SW: Percutaneous mitral valve repair
• K10plus-PPN: 1572433981

Abstract

Aims The aim of the present study was to assess the safety and efficacy of percutaneous mitral valve repair using the MitraClip™ device in patients with severely reduced systolic left ventricular (LV) function. Methods and results Among 777 MitraClip™ implantations included in the German mitral valve registry, we identified 256 patients suffering from severely reduced LV function [ejection fraction (EF) <30%] in whom successful percutaneous mitral valve repair was performed. Procedural safety, efficacy, and 1-year outcome was compared with 241 patients with preserved LV function (EF >50%) and 280 patients presenting with an EF 30-50% prior to MitraClip™ therapy. High procedural success rates, low periprocedural complication rates, and low residual mitral regurgitation grades at discharge were achieved throughout all groups. In-hospital mortality was low and comparable in all groups. After 1 year, mortality rates were 24.2% (EF <30%), 17.3% (EF 30-50%), and 18.9% (EF >50%). Major adverse cardiac or cardiovascular event rates were 29.7% (EF <30%), 24.4% (EF 30-50%), and 23.5% (EF >50%). Procedural failure was the main predictor for mortality in EF <30% patients (hazard ratio 10.38; 95% CI 3.71-29.02). Improved clinical symptoms were observed in the majority of patients in all groups. Thus, 69.5% of EF <30% patients improved by one or more New York Heart Association functional class. Compared with patients with preserved LV function, this is a significantly larger proportion (EF >50%: 56.8%; P < 0.05). Moreover, quality of life, being very poor at baseline, improved distinctively in severe heart failure patients. Conclusion In patients with severely reduced systolic LV function undergoing MitraClip™ therapy, procedural safety, efficacy, and clinical improvement after 1 year are comparable to patients with preserved LV function.