1
|
Mohammed H, Plicht B, Farah A, Ohlow M, El Garhy M, Hesham A, Ilse J, Schols W, Buck T. Transcatheter mitral valve repair (TMVR) using MitraClip in patients younger than 65 years: a multicenter analysis of 2-years outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background
TMVR using MitraClip became a well-established interventional therapy for severe MR. However, TMVR has been almost only applied to old aged patients rejected from surgical therapy.
Objective
To present 2-years outcomes of 36 patients younger than 65 years with no surgical options treated by TMVR.
Methods
A retrospective clinical and TEE study was conducted to evaluate 36 patients younger than 65 years treated by TMVR in 3 heart centers.
Results
Mean age of the 36 study patients was 56.3±6.6 years, male gender was 72.2%. High operative risk was estimated by STS score (mean = 8.73±2.97) and EuroSCORE (mean = 24.71±12.79). All patients were refused for surgery by heart team decision, therefore admitted to TMVR. Baseline severity of MR was assessed by 3D-TEE based biplane vena contracta width (mean = 8.35±1.87 mm). Baseline transmitral mean pressure gradient was 1.81±0.78 mmHg. 21 patients showed mitral annular dilatation as the main cause of MR, 8 patients had leaflet prolapse, 4 patients exhibited papillary muscle displacement leading to leaflet tethering and 3 patients showed mitral leaflet thickening and/or retraction due to fibrosis. Procedural success was achieved in all patients with 1/2/3 clips implanted in 52.8%/44.4%/2.8% of cases with a mean of 1.5 clip per case. Two grades or more reduction in severity of MR (MR grade ≤ II/IV) was accomplished in 88.9% of patients. Mean postprocedural MPG was 3.78±1.96 mmHg. Average follow-up (FU) period was 25,8 months and the median was 20 months (25th–75th percentile: 12–36 months). During 2-years FU, statistically significant difference (p value <0.002) was detected for NT-proBNP levels compared to baseline (mean = 9870±10819, median = 7748, 25th–75th percentile: 2702–14237 pg/ml) and at follow up visits (mean = 7645±11292, median = 3263, 25th-75th percentile: 883–8078 pg/ml). Furthermore, persistent symptomatic improvement during FU, defined as NYHA functional class improvement by 2 or more Grades, was achieved in 69% of patient in parallel with efficient reduction of MR in 34 patients so that a second intervention by reclipping was required in 2 patients to correct recurrent significant MR. Only two patients experienced procedure-related complications by large puncture site hematoma. No procedure-related mortality during the first 30 days was detected. However, mortality was recorded in 2 patients during the first month and was attributed to severe advanced heart failure in one case and septicemia after exclusion of infective endocarditis in another case. Over 2 years FU, other 5 patients passed away, 3 cases owing to advanced heart failure, one case due to multi-organ failure and one because of tumor disease.
Conclusion
TMVR in patients younger than 65 years refused from surgical repair provides satisfactory clinical and echocardiography outcomes at 2 years. Future studies should evaluate the outcomes of MitraClip in this population in a larger cohort.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hassan M.H. Mohammed received a scholarship grant from the Egyptian ministry of higher education and Minia University, Egypt.
Collapse
Affiliation(s)
- H Mohammed
- El-Minya University Hospital, El-Minya, Egypt
| | - B Plicht
- Westfalen Hospital Dortmund, Cardiology department, Dortmund, Germany
| | - A Farah
- Westfalen Hospital Dortmund, Cardiology department, Dortmund, Germany
| | - M Ohlow
- Central Clinic Bad Berka, Cardiology department, Bad Berka, Germany
| | - M El Garhy
- Central Clinic Bad Berka, Cardiology department, Bad Berka, Germany
| | - A Hesham
- Heart Center Duisburg, Cardiology department, Duisburg, Germany
| | - J Ilse
- Heart Center Duisburg, Cardiology department, Duisburg, Germany
| | - W Schols
- Heart Center Duisburg, Cardiology department, Duisburg, Germany
| | - T Buck
- Westfalen Hospital Dortmund, Cardiology department, Dortmund, Germany
| |
Collapse
|
2
|
Bendorf A, Kerridge I, Pussell B, Donadio C, Hesham A, Grassi G, Kanaki A, Barsotti M, Hertig A, Dubois-Xu YC, Buob D, Noel C, Rondeau E, Hazzan M, Dahle DO, Mjoen G, Marz W, Holme I, Fellstrom B, Jardine A, Holdaas H, Vincenti F, Larsen C, Alberu J, Duro Garcia V, Rostaing L, Rice K, Schnitzler M, Xing J, Agarwal M, Charpentier B. Transplantation / Clinical studies. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|