Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

Alberto Polimeni,Vincenzo Signorile,Nadia Salerno,Iolanda Aquila,Michele Cacia,Carmen Spaccarotella,Jolanda Sabatino,Isabella Leo,Salvatore De Rosa,Annalisa Mongiardo,Sabato Sorrentino,Ciro Indolfi,Michele Albanese

doi:10.1038/s41598-020-74407-z

Abstract

Percutaneous mitral valve repair has been increasingly performed worldwide after approval. We sought to investigate predictors of clinical outcome in patients with mitral regurgitation undergoing percutaneous valve repair. The MITRA-UMG study, a single-centre registry, retrospectively collected consecutive patients with symptomatic moderate-to-severe or severe MR undergoing MitraClip therapy. The primary endpoint was the composite of cardiovascular death or rehospitalization for heart failure. Between March 2012 and July 2018, a total of 150 consecutive patients admitted to our institution were included. Procedural success was obtained in 95.3% of patients. The composite primary endpoint of cardiovascular death or rehospitalization for HF was met in 55 patients (37.9%) with cumulative incidences of 7.6%, 26.2%, at 30 days and 1-year, respectively. In the Cox multivariate model, NYHA functional class and left ventricular end-diastolic volume index (LVEDVi), independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan–Meier analysis, a LVEDVi > 92 ml/m2 was associated with an increased incidence of the primary endpoint. In this study, patients presenting with dilated ventricles (LVEDVi > 92 ml/m2) and advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis after percutaneous mitral valve repair.

Highlights

Percutaneous mitral valve repair has been increasingly performed worldwide after approval
The percutaneous mitral valve repair (PMVR) with MitraClip (Abbott, USA) system is based on the edge-to-edge technique that was first described by the surgeon Ottavio Alfieri
PMVR was included as a treatment option in patients with severe Mitral valve regurgitation (MR) at high risk for surgery (Class IIb recommendation) in both the E SC5 and AHA/ACC6 guidelines

Summary

Introduction

Percutaneous mitral valve repair has been increasingly performed worldwide after approval. Patients presenting with dilated ventricles (LVEDVi > 92 ml/m2) and advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis after percutaneous mitral valve repair. The MITRA-FR trial shows no benefit of MitraClip with respect to medical therapy while COAPT was a strong positive trial in favor of the MitraClip intervention Possible reasons for this sharp discordance include more selective patient recruitment in the COAPT trial compared to MITRA-FR trial, more severe MR and less dilated ventricles (LVEDVi 101 ml/m2 vs 135 ml/m2, respectively). A single-centre retrospective registry, we sought to evaluate the clinical outcomes and to identify predictors of rehospitalization for heart failure or cardiovascular death from a registry of patients with MR undergoing PMVR with the MitraClip system

Methods

Results

Conclusion