Journal article
Two-year cardiac mortality after MitraClip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy.
- Godino C Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: cosmogodino@gmail.com.
- Scotti A Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Taramasso M Division of Cardiac Surgery, University Hospital Zurich, Switzerland.
- Adamo M Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
- Russo M Division of Cardiac Surgery, University Hospital Zurich, Switzerland.
- Chiarito M Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Melillo F Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Beneduce A Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Pivato CA Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Arrigoni L Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Toscano E Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Salerno A Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Cappelletti A Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Magni V Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Stella S Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Fragasso G Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Montorfano M Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Agricola E Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Ettori F Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy.
- Margonato A Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- Maisano F Division of Cardiac Surgery, University Hospital Zurich, Switzerland.
- Colombo A Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
- 2018-06-23
Published in:
- International journal of cardiology. - 2018
Functional mitral regurgitation
Heart failure
Ischemic aetiology
MitraClip
Mitral regurgitation
Aged
Aged, 80 and over
Cardiomyopathy, Dilated
Female
Follow-Up Studies
Hospital Mortality
Humans
Male
Middle Aged
Mitral Valve Insufficiency
Mortality
Myocardial Ischemia
Retrospective Studies
Surgical Instruments
Time Factors
Treatment Outcome
English
BACKGROUND
MitraClip implantation has evolved as a new tool for treatment of inoperable or high-risk patients with severe functional mitral regurgitation (FMR) due to dilated cardiomyopathy (DCM). Limited data are available regarding MitraClip outcomes comparing patients with ischemic and non-ischemic DCM.
METHODS
From 2008 to 2016, 314 patients received MitraClip for FMR at four institutions: Brescia, Zurich and Milan. Patients were stratified according to MR aetiology in non-ischemic FMR (n = 99) and ischemic FMR (n = 215). Preoperative risk factors, operative variables and outcomes up to 2-year were evaluated. A multivariable Cox Proportional Hazards survival model with covariate adjustments was used to assess the relationship between FMR aetiology and 2-year cardiac mortality.
RESULTS
As expected, patients with ischemic FMR had significantly more risk factors and comorbidities. Overall procedural success rate was 80% and in-hospital cardiac mortality was 3% without significant differences between aetiology. Two-year overall (25% vs. 19%, p = 0.574) and cardiac (18% vs. 16%, p = 0.990) mortality rates were comparable. No differences were detected in terms of re-hospitalization rates (32%), LVAD implantation (4.5%) and mitral valve surgery (1%). LVEF ≤ 25%, LVEDV > 216 ml, NT-proBNP ≥ 10.000 pg/ml and AF were the strongest baseline predictors of 2-year cardiac mortality. Greater improvements of 6MWT and NYHA functional class were observed in patients with non-ischemic FMR.
CONCLUSIONS
The ischemic or non-ischemic aetiology of DCM did not affect in-hospital and 2-year cardiac mortality after MitraClip in patients with FMR. In case of unfavorable baseline clinical condition, the indication for MitraClip should be carefully weighed in favour of conservative medical therapy alone or left ventricular assist device.
MitraClip implantation has evolved as a new tool for treatment of inoperable or high-risk patients with severe functional mitral regurgitation (FMR) due to dilated cardiomyopathy (DCM). Limited data are available regarding MitraClip outcomes comparing patients with ischemic and non-ischemic DCM.
METHODS
From 2008 to 2016, 314 patients received MitraClip for FMR at four institutions: Brescia, Zurich and Milan. Patients were stratified according to MR aetiology in non-ischemic FMR (n = 99) and ischemic FMR (n = 215). Preoperative risk factors, operative variables and outcomes up to 2-year were evaluated. A multivariable Cox Proportional Hazards survival model with covariate adjustments was used to assess the relationship between FMR aetiology and 2-year cardiac mortality.
RESULTS
As expected, patients with ischemic FMR had significantly more risk factors and comorbidities. Overall procedural success rate was 80% and in-hospital cardiac mortality was 3% without significant differences between aetiology. Two-year overall (25% vs. 19%, p = 0.574) and cardiac (18% vs. 16%, p = 0.990) mortality rates were comparable. No differences were detected in terms of re-hospitalization rates (32%), LVAD implantation (4.5%) and mitral valve surgery (1%). LVEF ≤ 25%, LVEDV > 216 ml, NT-proBNP ≥ 10.000 pg/ml and AF were the strongest baseline predictors of 2-year cardiac mortality. Greater improvements of 6MWT and NYHA functional class were observed in patients with non-ischemic FMR.
CONCLUSIONS
The ischemic or non-ischemic aetiology of DCM did not affect in-hospital and 2-year cardiac mortality after MitraClip in patients with FMR. In case of unfavorable baseline clinical condition, the indication for MitraClip should be carefully weighed in favour of conservative medical therapy alone or left ventricular assist device.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijcard.2018.06.041
- PMID 29929931
- Persistent URL
- https://folia.unifr.ch/global/documents/259918
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