Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction.

Dan Haberman,Maurizio Taramasso,Lian Krivoshei,Fabien Praz,Claudia Scardino,Mattia Di Pasquale,Davide Schiavi,Paolo Denti,Lion Poles,Marco Gennari,Mony Shuvy,Isaac Pascual,Andrew Czarnecki,Neil Fam,Konstantinos Spargias,Michael Chrissoheris,Vlasis Ninios,Doron Sudarsky,Ander Regueiro,Leor Perl,Julio Echarte-Morales,Sorel Goland,Noé Corpataux,Dabit Arzamendi,Igal Moaraf,Xavier Freixa,Marianna Adamo,Danny Dvir,Arthur Kerner,Sara Shimoni,Silvia Salvatore ,Rodrigo Estévez‐Loureiro ,Carlos Vergara-Uzcategui,Luís Nombela-Franco ,Andrés Íñiguez‐Romo ,Rоnen Beeri ,Estefanía Fernández Peregrina ,Pedro A Villablanca ,Berenice Caneiro‐Queija ,Haim Danenberg,Tomás Benito‐González ,Felipe Fernández‐Vazquez

doi:10.3390/jcm10091819

Abstract

Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)—35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF < 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p = 0.51 and 19% vs. 12%, p = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded.

Highlights

Mitral regurgitation (MR) complicating acute Myocaridial Infarction (MI) can be the result of papillary muscle rupture (Primary) or imbalance between closing and tethering forces (Functional)
The patient population was divided into two groups based on the median Left ventricle ejection fraction (LVEF) of 35%
Patients in the LVEF < 35% group were younger when compared to patients with LVEF ≥ 35% (68.4 ± 9.1 vs. 72.4 ± 11.0, p = 0.05), as well as having a higher body–mass index (BMI) (27.9 ± 4.7 vs. 25.5 ± 5.3, p = 0.04)

Summary

Introduction

Mitral regurgitation (MR) complicating acute Myocaridial Infarction (MI) can be the result of papillary muscle rupture (Primary) or imbalance between closing and tethering forces (Functional). Primary MR in this acute setting is a medical emergency often requires emergent intervention [1]. Functional mitral regurgitation (FMR) usually develops over the course of days and is associated with adverse outcomes [2]. Medical therapy is the mainstay approach for this condition. Data obtained from large-scale registries suggest that percutaneous transcatheter edge-to-edge mitral valve repair implantation with MitraClip device improves functional capacity and quality of life [4,5,6,7]. The recent randomized trial entitled, ‘Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure

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