Impact of cardiac comorbidities on early and 1-year outcome after percutaneous mitral valve interventions: data from the German transcatheter mitral valve interventions (TRAMI) registry.

Abstract

The use of the MitraClip system has gained widespread acceptance for the treatment of patients with mitral regurgitation (MR) who are not suitable for the conventional surgery. This study sought to investigate the early and 1-year outcome after MitraClip therapy of patients with MR and cardiac comorbidities. Outcomes through 12-month follow-up of patients (n=528) who underwent MitraClip implantation were obtained from the German transcatheter mitral valve interventions (TRAMI) registry. The majority of these patients (n=409, 77.5%) also suffered from coronary artery disease (CAD). Patients with a dilated cardiomyopathy (DCM, n=65, 12.3%) or concomitant valvular aortic disease (AV, n=54, 10.2%) were less frequent. Although the prevalent pathogenesis was functional MR, patients with DCM had significantly more frequent a functional MR (96.9%) compared to patients with CAD (74.9%) or AV (62.5%, p<0.001). Technical success was achieved in 97.5% of patients. Procedural echocardiograms demonstrated in the vast majority of patients a reduction from severe MR III to mild MR I with no difference between the groups (p=0.83). The peri-procedural complication rate was very low. At 30-day and 12-month follow-up, the majority of patients were in NYHA functional class II or lower. The rate of death, stroke, and myocardial infarction (MACCE) was comparable in the three patient groups during 12-month follow-up (DCM 26.9%, CAD 30.3% and AV 27.5%, p=0.85). The MitraClip implantation is feasible and safe even in high-risk patients with MR and cardiac comorbidities.