P209 Mitraclip - experience of a portuguese tertiary care center - mid-term review of results

Abstract

Abstract Background Mitral regurgitation (MR) is a marker of bad prognosis in heart failure (HF) patients (pts). Mitraclip implantation (MI) leads to a clinical improvement. Purpose To characterize the adult population submitted to MI and evaluate its mid-term results. Methods Prospective analysis of 40 pts with moderate to severe MR (grades III-IV) submitted to MI between 2013 and 2018. Paired sample t-test to assess the procedure’s effect on several variables. P-values < 0.05 were considered significant. Results 40pts, 60% male, with a mean age of 66 ± 12 years (Y) and mean follow-up time of 18 ± 15 months (M), of which 67.5% presented with grade IV MR (mean regurgitant volume - 43.5 ± 29 ml; mean EROA - 34.8 ± 13 mm2 ) and 75% with functional MR. Mean LVEF of 35%±10.3, with 55% presenting a LVEF < 35%. Mean Euroscore II of 6.0 ± 7. 27.5% had already undergone a previous cardiac surgery, in most cases CABG (63.6%). 30% had already suffered an acute coronary syndrome and 62.5% had atrial fibrillation. Mean pre-procedural peak VO2 of 14.5mL/kg/min and mean distance in the 6 minute walk test (6MWT) of 321 ± 100m. The device implantation was successful in 39 pts with a device success rate of 85% (successful implantation and reduction in MR to grade 2 or less), with 55% of pts presenting mild MR before discharge. There were immediate complications related to the procedure in 17.5% of pts, with 4pts experiencing tendinous cord rupture and 2pts leaflet tear. There were no cases of pericardial tamponade or embolic complications. Follow-up mortality of 30% (12pts), 9 deaths (D) due to cardiovascular events. 9D in the first-year post-procedure (1D within the first M), with 1 pt referred to cardiac surgery due leaflet tear and 1pt to heart transplantation. Successful MIwas associated with an improvement in NYHA functional class (3.0vs2.0, p < 0.001) and in several echocardiographic variables in the first 6M following the procedure: left ventricular (LV) end diastolic volume: 194.5mLvs168.4mL, p = 0.012; LV end systolic volume: 132.6mLvs106.7mL, p = 0.008; systolic pulmonary artery pressure: 50.5mmHgvs40.8mmHg, p = 0.013. It was also associated with a significant improvement in both 6M peak VO2 (14.4vs15.5, p = 0.028) and 6MWT distance (321.3mvs374m, p < 0.001). Conclusion MI is a safe procedure with a low rate of periprocedural complications. It’s associated with a functional class improvement and a significant reverse left ventricular remodeling.