MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: Mid-term results of a single-centre experience

Michele De Bonis, Maurizio Taramasso, Elisabetta Lapenna, Paolo Denti, Giovanni La Canna, Nicola Buzzatti, Federico Pappalardo, Giovanna Di Giannuario, Micaela Cioni, Andrea Giacomini, Ottavio Alfieri

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVES: To compare the surgical and percutaneous edge-to-edge (EE) repair in patients with severe left ventricular (LV) dysfunction and secondary mitral regurgitation (MR). METHODS: We reviewed the prospectively collected data of the first 120 consecutive patients (age: 65 ± 9.8 years, EF: 28 ± 8.2%) treated with surgical (65 patients) or percutaneous (55 patients) EE repair for severe secondary MR in our institution. Age (P = 0.005) and logistic European System for Cardiac Operative Risk Evaluation (P <0.0001) were significantly higher in the MitraClip group. LVEF (P = 0.37), enddiastolic (P = 0.83) and end-systolic (P = 0.68) volumes and systolic pulmonary artery pressure (SPAP) (P = 0.58) were similar. The follow-up was 100% complete [median: 4 years; interquartile range (IQR): 2.2-7.2]. RESULTS: The length of hospital stay was 10 days (IQR: 8-13) for surgery and 5 days (IQR: 3.9-7.8) forMitraClip (P <0.0001). Hospitalmortality (3 vs 0%, P = 0.49) and freedom from cardiac death at 4 years (80.8 ± 4.9% vs 79.1 ± 5.9%, P = 0.9) were not significantly different in the surgical and MitraClip group, respectively. Residual MR = 2+ at hospital discharge was 7.6% for surgery and 29% for MitraClip (P = 0.002). At 4 years, freedom fromMR = 2+ (74.9 ± 5.6% vs 51.4 ± 7.4%, P = 0.01) and freedom from MR= 3+ (92.8 ± 3.4%vs 68.1 ± 7%, P = 0.002) were both significantly higher in the surgical group. Multivariate analysis identified the use of MitraClip as an independent predictor of recurrence of MR = 2+ [Hazard ratio (HR): 2.1, 95% confidence interval (CI): 1.1-3.9, P = 0.02] as well as of MR= 3 (HR: 6.1, 95% CI: 1.5-24.3, P = 0.01). In the surgical group, no predictors of cardiac mortality were identified. In the MitraClip group, left ventricular end-diastolic diameter (HR: 1.1, 95% CI: 1-1.2, P = 0.005) and SPAP (HR: 1, 95% CI: 1-1.1, P = 0.005) were independent predictors of cardiac death at the follow-up. CONCLUSIONS: MitraClip therapy is a safe therapeutic option in selected high-risk patients with secondary MR and relevant comorbidities. The surgical EE provides higher efficacy both postoperatively and at the mid-term follow-up.

Original languageEnglish
Pages (from-to)255-262
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume49
Issue number1
DOIs
Publication statusPublished - 2016

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Mitral Valve Insufficiency
Left Ventricular Dysfunction
Confidence Intervals
Pulmonary Artery
Therapeutics
Length of Stay
Pressure
Ambulatory Surgical Procedures
Comorbidity
Multivariate Analysis
Recurrence
Mortality

Keywords

  • MitraClip
  • Mitral valve repair
  • Percutaneous mitral repair
  • Secondary mitral regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation : Mid-term results of a single-centre experience. / De Bonis, Michele; Taramasso, Maurizio; Lapenna, Elisabetta; Denti, Paolo; La Canna, Giovanni; Buzzatti, Nicola; Pappalardo, Federico; Di Giannuario, Giovanna; Cioni, Micaela; Giacomini, Andrea; Alfieri, Ottavio.

In: European Journal of Cardio-thoracic Surgery, Vol. 49, No. 1, 2016, p. 255-262.

Research output: Contribution to journalArticle

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title = "MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: Mid-term results of a single-centre experience",
abstract = "OBJECTIVES: To compare the surgical and percutaneous edge-to-edge (EE) repair in patients with severe left ventricular (LV) dysfunction and secondary mitral regurgitation (MR). METHODS: We reviewed the prospectively collected data of the first 120 consecutive patients (age: 65 ± 9.8 years, EF: 28 ± 8.2{\%}) treated with surgical (65 patients) or percutaneous (55 patients) EE repair for severe secondary MR in our institution. Age (P = 0.005) and logistic European System for Cardiac Operative Risk Evaluation (P <0.0001) were significantly higher in the MitraClip group. LVEF (P = 0.37), enddiastolic (P = 0.83) and end-systolic (P = 0.68) volumes and systolic pulmonary artery pressure (SPAP) (P = 0.58) were similar. The follow-up was 100{\%} complete [median: 4 years; interquartile range (IQR): 2.2-7.2]. RESULTS: The length of hospital stay was 10 days (IQR: 8-13) for surgery and 5 days (IQR: 3.9-7.8) forMitraClip (P <0.0001). Hospitalmortality (3 vs 0{\%}, P = 0.49) and freedom from cardiac death at 4 years (80.8 ± 4.9{\%} vs 79.1 ± 5.9{\%}, P = 0.9) were not significantly different in the surgical and MitraClip group, respectively. Residual MR = 2+ at hospital discharge was 7.6{\%} for surgery and 29{\%} for MitraClip (P = 0.002). At 4 years, freedom fromMR = 2+ (74.9 ± 5.6{\%} vs 51.4 ± 7.4{\%}, P = 0.01) and freedom from MR= 3+ (92.8 ± 3.4{\%}vs 68.1 ± 7{\%}, P = 0.002) were both significantly higher in the surgical group. Multivariate analysis identified the use of MitraClip as an independent predictor of recurrence of MR = 2+ [Hazard ratio (HR): 2.1, 95{\%} confidence interval (CI): 1.1-3.9, P = 0.02] as well as of MR= 3 (HR: 6.1, 95{\%} CI: 1.5-24.3, P = 0.01). In the surgical group, no predictors of cardiac mortality were identified. In the MitraClip group, left ventricular end-diastolic diameter (HR: 1.1, 95{\%} CI: 1-1.2, P = 0.005) and SPAP (HR: 1, 95{\%} CI: 1-1.1, P = 0.005) were independent predictors of cardiac death at the follow-up. CONCLUSIONS: MitraClip therapy is a safe therapeutic option in selected high-risk patients with secondary MR and relevant comorbidities. The surgical EE provides higher efficacy both postoperatively and at the mid-term follow-up.",
keywords = "MitraClip, Mitral valve repair, Percutaneous mitral repair, Secondary mitral regurgitation",
author = "{De Bonis}, Michele and Maurizio Taramasso and Elisabetta Lapenna and Paolo Denti and {La Canna}, Giovanni and Nicola Buzzatti and Federico Pappalardo and {Di Giannuario}, Giovanna and Micaela Cioni and Andrea Giacomini and Ottavio Alfieri",
year = "2016",
doi = "10.1093/ejcts/ezv043",
language = "English",
volume = "49",
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journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
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TY - JOUR

T1 - MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation

T2 - Mid-term results of a single-centre experience

AU - De Bonis, Michele

AU - Taramasso, Maurizio

AU - Lapenna, Elisabetta

AU - Denti, Paolo

AU - La Canna, Giovanni

AU - Buzzatti, Nicola

AU - Pappalardo, Federico

AU - Di Giannuario, Giovanna

AU - Cioni, Micaela

AU - Giacomini, Andrea

AU - Alfieri, Ottavio

PY - 2016

Y1 - 2016

N2 - OBJECTIVES: To compare the surgical and percutaneous edge-to-edge (EE) repair in patients with severe left ventricular (LV) dysfunction and secondary mitral regurgitation (MR). METHODS: We reviewed the prospectively collected data of the first 120 consecutive patients (age: 65 ± 9.8 years, EF: 28 ± 8.2%) treated with surgical (65 patients) or percutaneous (55 patients) EE repair for severe secondary MR in our institution. Age (P = 0.005) and logistic European System for Cardiac Operative Risk Evaluation (P <0.0001) were significantly higher in the MitraClip group. LVEF (P = 0.37), enddiastolic (P = 0.83) and end-systolic (P = 0.68) volumes and systolic pulmonary artery pressure (SPAP) (P = 0.58) were similar. The follow-up was 100% complete [median: 4 years; interquartile range (IQR): 2.2-7.2]. RESULTS: The length of hospital stay was 10 days (IQR: 8-13) for surgery and 5 days (IQR: 3.9-7.8) forMitraClip (P <0.0001). Hospitalmortality (3 vs 0%, P = 0.49) and freedom from cardiac death at 4 years (80.8 ± 4.9% vs 79.1 ± 5.9%, P = 0.9) were not significantly different in the surgical and MitraClip group, respectively. Residual MR = 2+ at hospital discharge was 7.6% for surgery and 29% for MitraClip (P = 0.002). At 4 years, freedom fromMR = 2+ (74.9 ± 5.6% vs 51.4 ± 7.4%, P = 0.01) and freedom from MR= 3+ (92.8 ± 3.4%vs 68.1 ± 7%, P = 0.002) were both significantly higher in the surgical group. Multivariate analysis identified the use of MitraClip as an independent predictor of recurrence of MR = 2+ [Hazard ratio (HR): 2.1, 95% confidence interval (CI): 1.1-3.9, P = 0.02] as well as of MR= 3 (HR: 6.1, 95% CI: 1.5-24.3, P = 0.01). In the surgical group, no predictors of cardiac mortality were identified. In the MitraClip group, left ventricular end-diastolic diameter (HR: 1.1, 95% CI: 1-1.2, P = 0.005) and SPAP (HR: 1, 95% CI: 1-1.1, P = 0.005) were independent predictors of cardiac death at the follow-up. CONCLUSIONS: MitraClip therapy is a safe therapeutic option in selected high-risk patients with secondary MR and relevant comorbidities. The surgical EE provides higher efficacy both postoperatively and at the mid-term follow-up.

AB - OBJECTIVES: To compare the surgical and percutaneous edge-to-edge (EE) repair in patients with severe left ventricular (LV) dysfunction and secondary mitral regurgitation (MR). METHODS: We reviewed the prospectively collected data of the first 120 consecutive patients (age: 65 ± 9.8 years, EF: 28 ± 8.2%) treated with surgical (65 patients) or percutaneous (55 patients) EE repair for severe secondary MR in our institution. Age (P = 0.005) and logistic European System for Cardiac Operative Risk Evaluation (P <0.0001) were significantly higher in the MitraClip group. LVEF (P = 0.37), enddiastolic (P = 0.83) and end-systolic (P = 0.68) volumes and systolic pulmonary artery pressure (SPAP) (P = 0.58) were similar. The follow-up was 100% complete [median: 4 years; interquartile range (IQR): 2.2-7.2]. RESULTS: The length of hospital stay was 10 days (IQR: 8-13) for surgery and 5 days (IQR: 3.9-7.8) forMitraClip (P <0.0001). Hospitalmortality (3 vs 0%, P = 0.49) and freedom from cardiac death at 4 years (80.8 ± 4.9% vs 79.1 ± 5.9%, P = 0.9) were not significantly different in the surgical and MitraClip group, respectively. Residual MR = 2+ at hospital discharge was 7.6% for surgery and 29% for MitraClip (P = 0.002). At 4 years, freedom fromMR = 2+ (74.9 ± 5.6% vs 51.4 ± 7.4%, P = 0.01) and freedom from MR= 3+ (92.8 ± 3.4%vs 68.1 ± 7%, P = 0.002) were both significantly higher in the surgical group. Multivariate analysis identified the use of MitraClip as an independent predictor of recurrence of MR = 2+ [Hazard ratio (HR): 2.1, 95% confidence interval (CI): 1.1-3.9, P = 0.02] as well as of MR= 3 (HR: 6.1, 95% CI: 1.5-24.3, P = 0.01). In the surgical group, no predictors of cardiac mortality were identified. In the MitraClip group, left ventricular end-diastolic diameter (HR: 1.1, 95% CI: 1-1.2, P = 0.005) and SPAP (HR: 1, 95% CI: 1-1.1, P = 0.005) were independent predictors of cardiac death at the follow-up. CONCLUSIONS: MitraClip therapy is a safe therapeutic option in selected high-risk patients with secondary MR and relevant comorbidities. The surgical EE provides higher efficacy both postoperatively and at the mid-term follow-up.

KW - MitraClip

KW - Mitral valve repair

KW - Percutaneous mitral repair

KW - Secondary mitral regurgitation

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