Percutaneous mitral valve repair

The last chance for symptoms improvement in advanced refractory chronic heart failure?

Alessandra Berardini, Elena Biagini, Francesco Saia, Davide Stolfo, Mario Previtali, Francesco Grigioni, Bruno Pinamonti, Gabriele Crimi, Alessandro Salvi, Maurizio Ferrario, Antonio De Luca, Fabrizio Gazzoli, Maria Letizia Bacchi Reggiani, Claudia Raineri, Gianfranco Sinagra, Claudio Rapezzi

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear. Methods Seventy-five consecutive patients with FMR grade ≥ 3 + and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month. Results Mean age was 67 ± 11 years, logistic EuroSCORE = 23 ± 18%, left ventricle ejection fraction (LVEF) 30 ± 9%. In 6 patients (8%) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3% (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84%) were discharged with MR ≤ 2 +. At 6-month, 4 patients died (5%), 80% had MR ≤ 2 + and 75% were in New York Heart Association class ≤ II. Median pro-BNP decreased from 4395 pg/ml to 2594 pg/ml (p = 0.04). There were no significant changes in LV end-diastolic volume (222 ± 75 ml vs. 217 ± 79, p = 0.19), end-systolic volume (LVESV, 154 ± 66 ml vs. 156 ± 69, p = 0.54) and LVEF (30 ± 9% vs. 30 ± 12%, p = 0.86). Significant reverse remodeling (reduction of LVESV ≥ 10%) was observed in 25%, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6 months before PMVR were reduced from 1.1 ± 0.8 to 0.3 ± 0.6 (p < 0.001). Conclusions In extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6 months, despite the lack of LV reverse remodeling.

Original languageEnglish
Pages (from-to)191-197
Number of pages7
JournalInternational Journal of Cardiology
Volume228
DOIs
Publication statusPublished - Feb 1 2017

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Mitral Valve
Heart Failure
Mitral Valve Insufficiency
Heart Ventricles
Hospitalization
Diuretics
Thoracic Surgery
Echocardiography
Transplants
Therapeutics

Keywords

  • Heart failure
  • Mitral regurgitation
  • Percutaneous mitral valve repair
  • Remodeling

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous mitral valve repair : The last chance for symptoms improvement in advanced refractory chronic heart failure? / Berardini, Alessandra; Biagini, Elena; Saia, Francesco; Stolfo, Davide; Previtali, Mario; Grigioni, Francesco; Pinamonti, Bruno; Crimi, Gabriele; Salvi, Alessandro; Ferrario, Maurizio; De Luca, Antonio; Gazzoli, Fabrizio; Bacchi Reggiani, Maria Letizia; Raineri, Claudia; Sinagra, Gianfranco; Rapezzi, Claudio.

In: International Journal of Cardiology, Vol. 228, 01.02.2017, p. 191-197.

Research output: Contribution to journalArticle

Berardini, A, Biagini, E, Saia, F, Stolfo, D, Previtali, M, Grigioni, F, Pinamonti, B, Crimi, G, Salvi, A, Ferrario, M, De Luca, A, Gazzoli, F, Bacchi Reggiani, ML, Raineri, C, Sinagra, G & Rapezzi, C 2017, 'Percutaneous mitral valve repair: The last chance for symptoms improvement in advanced refractory chronic heart failure?', International Journal of Cardiology, vol. 228, pp. 191-197. https://doi.org/10.1016/j.ijcard.2016.11.241
Berardini, Alessandra ; Biagini, Elena ; Saia, Francesco ; Stolfo, Davide ; Previtali, Mario ; Grigioni, Francesco ; Pinamonti, Bruno ; Crimi, Gabriele ; Salvi, Alessandro ; Ferrario, Maurizio ; De Luca, Antonio ; Gazzoli, Fabrizio ; Bacchi Reggiani, Maria Letizia ; Raineri, Claudia ; Sinagra, Gianfranco ; Rapezzi, Claudio. / Percutaneous mitral valve repair : The last chance for symptoms improvement in advanced refractory chronic heart failure?. In: International Journal of Cardiology. 2017 ; Vol. 228. pp. 191-197.
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abstract = "Background The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear. Methods Seventy-five consecutive patients with FMR grade ≥ 3 + and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month. Results Mean age was 67 ± 11 years, logistic EuroSCORE = 23 ± 18{\%}, left ventricle ejection fraction (LVEF) 30 ± 9{\%}. In 6 patients (8{\%}) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3{\%} (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84{\%}) were discharged with MR ≤ 2 +. At 6-month, 4 patients died (5{\%}), 80{\%} had MR ≤ 2 + and 75{\%} were in New York Heart Association class ≤ II. Median pro-BNP decreased from 4395 pg/ml to 2594 pg/ml (p = 0.04). There were no significant changes in LV end-diastolic volume (222 ± 75 ml vs. 217 ± 79, p = 0.19), end-systolic volume (LVESV, 154 ± 66 ml vs. 156 ± 69, p = 0.54) and LVEF (30 ± 9{\%} vs. 30 ± 12{\%}, p = 0.86). Significant reverse remodeling (reduction of LVESV ≥ 10{\%}) was observed in 25{\%}, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6 months before PMVR were reduced from 1.1 ± 0.8 to 0.3 ± 0.6 (p < 0.001). Conclusions In extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6 months, despite the lack of LV reverse remodeling.",
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T1 - Percutaneous mitral valve repair

T2 - The last chance for symptoms improvement in advanced refractory chronic heart failure?

AU - Berardini, Alessandra

AU - Biagini, Elena

AU - Saia, Francesco

AU - Stolfo, Davide

AU - Previtali, Mario

AU - Grigioni, Francesco

AU - Pinamonti, Bruno

AU - Crimi, Gabriele

AU - Salvi, Alessandro

AU - Ferrario, Maurizio

AU - De Luca, Antonio

AU - Gazzoli, Fabrizio

AU - Bacchi Reggiani, Maria Letizia

AU - Raineri, Claudia

AU - Sinagra, Gianfranco

AU - Rapezzi, Claudio

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear. Methods Seventy-five consecutive patients with FMR grade ≥ 3 + and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month. Results Mean age was 67 ± 11 years, logistic EuroSCORE = 23 ± 18%, left ventricle ejection fraction (LVEF) 30 ± 9%. In 6 patients (8%) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3% (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84%) were discharged with MR ≤ 2 +. At 6-month, 4 patients died (5%), 80% had MR ≤ 2 + and 75% were in New York Heart Association class ≤ II. Median pro-BNP decreased from 4395 pg/ml to 2594 pg/ml (p = 0.04). There were no significant changes in LV end-diastolic volume (222 ± 75 ml vs. 217 ± 79, p = 0.19), end-systolic volume (LVESV, 154 ± 66 ml vs. 156 ± 69, p = 0.54) and LVEF (30 ± 9% vs. 30 ± 12%, p = 0.86). Significant reverse remodeling (reduction of LVESV ≥ 10%) was observed in 25%, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6 months before PMVR were reduced from 1.1 ± 0.8 to 0.3 ± 0.6 (p < 0.001). Conclusions In extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6 months, despite the lack of LV reverse remodeling.

AB - Background The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear. Methods Seventy-five consecutive patients with FMR grade ≥ 3 + and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month. Results Mean age was 67 ± 11 years, logistic EuroSCORE = 23 ± 18%, left ventricle ejection fraction (LVEF) 30 ± 9%. In 6 patients (8%) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3% (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84%) were discharged with MR ≤ 2 +. At 6-month, 4 patients died (5%), 80% had MR ≤ 2 + and 75% were in New York Heart Association class ≤ II. Median pro-BNP decreased from 4395 pg/ml to 2594 pg/ml (p = 0.04). There were no significant changes in LV end-diastolic volume (222 ± 75 ml vs. 217 ± 79, p = 0.19), end-systolic volume (LVESV, 154 ± 66 ml vs. 156 ± 69, p = 0.54) and LVEF (30 ± 9% vs. 30 ± 12%, p = 0.86). Significant reverse remodeling (reduction of LVESV ≥ 10%) was observed in 25%, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6 months before PMVR were reduced from 1.1 ± 0.8 to 0.3 ± 0.6 (p < 0.001). Conclusions In extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6 months, despite the lack of LV reverse remodeling.

KW - Heart failure

KW - Mitral regurgitation

KW - Percutaneous mitral valve repair

KW - Remodeling

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