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- Title
142 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.
- Authors
De Bonis, M.; Taramasso, M.; Lapenna, E.; Denti, P.; Canna, G. La; Pappalardo, F.; Cioni, M.; Alfieri, O.
- 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 EuroSCORE (P < 0.0001) were significantly higher in the Mitraclip group. Left ventricular EF (P = 0.3), end-diastolic (P = 0.9) and end-systolic (P = 0.9) volumes and SPAP (P = 0.5) were similar. Follow-up was 100% complete (median 3.5 years; IQR 1.7; 6).Results: Length of hospital stay was 10 days (IQR: 8; 13) for surgery and 5 days (IQR: 3.9–7.8) for Mitraclip (P < 0.0001). Hospital mortality (3% vs 0%, P = 0.3) and freedom from cardiac death at 3.5 years (80 ± 5% vs 82 ± 5.9%, P = 0.6) were not significantly different. Residual MR ≥2+ at hospital discharge was 9.1% for surgery and 29% for Mitraclip (P = 0.01). At 3.5 years, freedom from MR ≥3+ (92 ± 3.5% vs 67 ± 7.3%, P = 0.002) and freedom from MR ≥2+ (76 ± 5.4% vs 46 ± 8.3%, P = 0.009) were both significantly higher in the surgical group. Multivariate analysis identified the use of Mitraclip as an independent predictor of recurrence of MR ≥3 (HR 5.9, 95% CI 1.5–22.5, P = 0.009) and the presence of residual MR ≥2+ at hospital discharge as the only significant risk factor for cardiac mortality (HR 2.9, 95% CI 1–8, P = 0.03).Conclusion: 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 mid-term follow-up.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2014, Vol 19, Issue suppl_1, pS44
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivu276.142