Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1627924
Oral Presentations
Sunday, February 18, 2018
DGTHG: Catheter-based Valvular Therapies - AV Valves
Georg Thieme Verlag KG Stuttgart · New York

Echocardiographic Analysis and Outcome in Patients with Functional Mitral Regurgitation Receiving MitraClip Therapy

D. Reichart
1   Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
,
D. Kalbacher
2   Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
,
N. Rübsamen
2   Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
,
E. Tigges
2   Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
,
J. Schirmer
1   Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
,
H. Reichenspurner
1   Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
,
S. Blankenberg
2   Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
,
L. Conradi
1   Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
,
U. Schäfer
2   Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
,
E. Girdauskas
1   Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
,
E. Lubos
2   Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objectives: MitraClip therapy has proved to be safe and effective for high-risk surgical patients with degenerative mitral regurgitation (MR), but data regarding functional MR (FMR) are sparse. We assessed echocardiographic parameters and outcome in FMR patients receiving MitraClip therapy.

Methods: From 09/2008 to 10/2016, a total of 466 patients with FMR received MitraClip therapy at our center. Follow-ups (FU) were conducted after 6/12 months; annually thereafter until the 5th postinterventional year. Groups were compared by χ2 tests. Changes in echocardiographic parameters from baseline to 12-month FU were examined by paired t-tests.

Results: Mean age was 74.0 ± 8.8 years; 298 patients were male. Mean logistic EuroSCORE I/STS score was 26.1 ± 17.2/5.5 ± 4.9. All patients were graded MR≥3+ at baseline. Mean left ventricular ejection fraction (LVEF) was 36.2 ± 13.7% and 49.8% of the patients showed LVEDD< 65mm. A mean of 1.5 ± 0.7 clips were implanted. Immediate procedural success was achieved in 92.7% of the patients. At discharge, 54.9% of patients were graded with residual MR (rMR)≤1+, 37.8% with rMR = 2+ and 7.3% with rMR≥3+. No significant differences in rMR distribution were seen in both LVEDD groups (< 65mm vs ≥65 mm, p > 0.05) at discharge. The 12-month echocardiographic FU (n = 224) showed that 43.8% of the patients were graded with rMR≤1+, 44.6% with rMR = 2+ and 11.6% with rMR ≥3+. LVEDD/LVESD decreased from 66.0 ± 10.7/54.3 ± 12mm to 64.9 ± 11.3/53.4 ± 13.8mm (p = 0.03/0.14). LVEF remained stable with 35.9 ± 14.6% (baseline: 37.5 ± 14.4%, p = 0.06). Percentages of patients with rMR = 2+ (41.6% vs 49.0%, p = 0.32) and rMR≥3+ (7.9 vs. 15.3%, p = 0.12) were not significantly different in the LVEDD < 65 mm and LVEDD ≥65 mm group, whereas the number of patients with rMR ≤1+ was significantly higher in the LVEDD < 65 mm group (50.5 vs 33.7%, p = 0.04). Cumulative survival of FMR patients at 1, 2 and 5 years was 75.2, 59.2, and 33.5%. NYHA class improved significantly from 3.2 ± 0.5 to 2.2 ± 0.7 within 12 months (p < 0.01). Within 5 years of FU, 24 patients needed repeat MitraClip therapy; 14 patients had mitral valve replacement.

Conclusion: MitraClip therapy results in acceptable clinical outcome in FMR patients. A tendency toward ongoing reverse left ventricular remodeling in all FMR patients could be demonstrated at 12-month FU. Better quantitative stratification of FMR patients is warranted to predict an optimal post-interventional result after MitraClip therapy and the associated clinical outcome.