Advertisement

Usefulness of Age (≥85 Years) and Residual Mitral Regurgitation (>1+/4+) for the Prediction of Adverse Outcomes in Patients Receiving the MitraClip

      The goal of this study was to determine the predictors of adverse clinical outcomes in patients treated with the MitraClip for significant mitral regurgitation (MR) with a focus on acute changes in hemodynamics and cardiac function. This retrospective study included 63 patients (mean age 82 ± 8 years, 48% male) with moderate to severe or severe MR. Cardiac catheterization was performed before and immediately after MitraClip repair. Volumetric and functional changes were assessed in both ventricles. A major adverse cardiac event was defined as a composite of cardiac death and readmission for heart failure. Patients were followed up on average for 380 days. MR was improved in 92% of patients after MitraClip therapy from an average grade of 4+ to <2+ (p <0.001). The pulmonary capillary wedge pressure decreased from 22 ± 7 mm Hg to 19 ± 6 mm Hg (p <0.001), and the cardiac stroke volume increased by 28% from 102 ± 53 ml to 131 ± 54 ml (p <0.001). The left ventricular end-diastolic volume was significantly reduced 24 hours after MitraClip therapy compared to that at baseline (p = 0.001). In the multivariate Cox proportion hazard regression model, an age ≥85 years (p <0.001) and residual MR >1+ (p <0.048) were predictors of an adverse prognosis at follow-up. In conclusion, a reduced left ventricular end-diastolic volume and improved hemodynamics occurred early after MitraClip therapy. An advanced age (≥85 years) and residual MR >1+ were associated with an increased risk of mortality and heart failure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • De Backer O
        • Piazza N
        • Banai S
        • Lutter G
        • Maisano F
        • Herrmann HC
        • Franzen OW
        • Sondergaard L
        Percutaneous transcatheter mitral valve replacement: an overview of devices in preclinical and early clinical evaluation.
        Circ Cardiovasc Interv. 2014; 7: 400-409
        • Pfister R
        • Baldus S
        Atrioventricular valve disease: challenges and achievements in percutaneous treatment.
        Clin Res Cardiol. 2018; 107: 88-93
        • Whitlow PL
        • Feldman T
        • Pedersen WR
        • Lim DS
        • Kipperman R
        • Smalling R
        • Bajwa T
        • Herrmann HC
        • Lasala J
        • Maddux JT
        • Tuzcu M
        • Kapadia S
        • Trento A
        • Siegel RJ
        • Foster E
        • Glower D
        • Mauri L
        • Kar S
        Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study.
        J Am Coll Cardiol. 2012; 59: 130-139
        • Nishimura RA
        • Otto CM
        • Bonow RO
        • Carabello BA
        • Erwin JP
        • 3rd Fleisher LA
        • Jneid H
        • Mack MJ
        • McLeod CJ
        • O'Gara PT
        • Rigolin VH
        • Sundt 3rd, TM
        • Thompson A
        2017 AHA/ACC Focused Update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        Circulation. 2017; 135: e1159-e1195
        • Quintana E
        • Suri RM
        • Thalji NM
        • Daly RC
        • Dearani JA
        • Burkhart HM
        • Li Z
        • Enriquez-Sarano M
        • Schaff HV
        Left ventricular dysfunction after mitral valve repair–the fallacy of “normal” preoperative myocardial function.
        J Thorac Cardiovasc Surg. 2014; 148: 2752-2760
        • Surder D
        • Pedrazzini G
        • Gaemperli O
        • Biaggi P
        • Felix C
        • Rufibach K
        • der Maur CA
        • Jeger R
        • Buser P
        • Kaufmann BA
        • Moccetti M
        • Hurlimann D
        • Buhler I
        • Bettex D
        • Scherman J
        • Pasotti E
        • Faletra FF
        • Zuber M
        • Moccetti T
        • Luscher TF
        • Erne P
        • Grunenfelder J
        • Corti R
        Predictors for efficacy of percutaneous mitral valve repair using the MitraClip system: the results of the MitraSwiss registry.
        Heart. 2013; 99: 1034-1040
        • Tribouilloy C
        • Rusinaru D
        • Szymanski C
        • Mezghani S
        • Fournier A
        • Levy F
        • Peltier M
        • Ben Ammar A
        • Carmi D
        • Remadi JP
        • Caus T
        • Touati G
        Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction.
        Eur J Echocardiogr. 2011; 12: 702-710
        • Magruder JT
        • Crawford TC
        • Grimm JC
        • Fredi JL
        • Shah AS
        Managing mitral regurgitation: focus on the MitraClip device.
        Med Devices (Auckl). 2016; 9: 53-60
        • Lang RM
        • Badano LP
        • Mor-Avi V
        • Afilalo J
        • Armstrong A
        • Ernande L
        • Flachskampf FA
        • Foster E
        • Goldstein SA
        • Kuznetsova T
        • Lancellotti P
        • Muraru D
        • Picard MH
        • Rietzschel ER
        • Rudski L
        • Spencer KT
        • Tsang W
        • Voigt JU
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
        • Bednar F
        • Budesinsky T
        • Linkova H
        • Kocka V
        Invasive Hemodynamic Assessment of Cardiac Output State after MitraClip Therapy in Nonanaesthetized Patients with Functional Mitral Regurgitation.
        Biomed Res Int. 2016; 20166296972
        • Kreusser MM
        • Geis NA
        • Berlin N
        • Greiner S
        • Pleger ST
        • Bekeredjian R
        • Katus HA
        • Raake PW
        Invasive hemodynamics and cardiac biomarkers to predict outcomes after percutaneous edge-to-edge mitral valve repair in patients with severe heart failure.
        Clin Res Cardiol. 2019; 108: 375-387
        • Siegel RJ
        • Biner S
        • Rafique AM
        • Rinaldi M
        • Lim S
        • Fail P
        • Hermiller J
        • Smalling R
        • Whitlow PL
        • Herrmann HC
        • Foster E
        • Feldman T
        • Glower D
        • Kar S
        • Investigators E
        The acute hemodynamic effects of MitraClip therapy.
        J Am Coll Cardiol. 2011; 57: 1658-1665
        • Feldman T
        • Foster E
        • Glower DD
        • Kar S
        • Rinaldi MJ
        • Fail PS
        • Smalling RW
        • Siegel R
        • Rose GA
        • Engeron E
        • Loghin C
        • Trento A
        • Skipper ER
        • Fudge T
        • Letsou GV
        • Massaro JM
        • Mauri L
        • Investigators EI
        Percutaneous repair or surgery for mitral regurgitation.
        N Engl J Med. 2011; 364: 1395-1406
        • Feldman T
        • Kar S
        • Elmariah S
        • Smart SC
        • Trento A
        • Siegel RJ
        • Apruzzese P
        • Fail P
        • Rinaldi MJ
        • Smalling RW
        • Hermiller JB
        • Heimansohn D
        • Gray WA
        • Grayburn PA
        • Mack MJ
        • Lim DS
        • Ailawadi G
        • Herrmann HC
        • Acker MA
        • Silvestry FE
        • Foster E
        • Wang A
        • Glower DD
        • Mauri L
        Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II.
        J Am Coll Cardiol. 2015; 66: 2844-2854
        • Wunderlich NC
        • Siegel RJ.
        Peri-interventional echo assessment for the MitraClip procedure.
        Eur Heart J Cardiovasc Imaging. 2013; 14: 935-949
        • Feldman T
        • Kar S
        • Rinaldi M
        • Fail P
        • Hermiller J
        • Smalling R
        • Whitlow PL
        • Gray W
        • Low R
        • Herrmann HC
        • Lim S
        • Foster E
        • Glower D
        • Investigators E
        Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort.
        J Am Coll Cardiol. 2009; 54: 686-694
        • Feldman T
        • Wasserman HS
        • Herrmann HC
        • Gray W
        • Block PC
        • Whitlow P
        • St Goar F
        • Rodriguez L
        • Silvestry F
        • Schwartz A
        • Sanborn TA
        • Condado JA
        • Foster E
        Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST Phase I Clinical Trial.
        J Am Coll Cardiol. 2005; 46: 2134-2140
        • Takagi H
        • Ando T
        • Umemoto T
        • Group A
        A review of comparative studies of MitraClip versus surgical repair for mitral regurgitation.
        Int J Cardiol. 2017; 228: 289-294
        • Anyanwu AC
        • Adams DH
        Evaluating catheter-based mitral valve therapies: lessons learned and future directions.
        J Am Coll Cardiol. 2015; 66: 2855-2859
        • Downs EA
        • Lim DS
        • Saji M
        • Ailawadi G
        Current state of transcatheter mitral valve repair with the MitraClip.
        Ann Cardiothorac Surg. 2015; 4: 335-340
        • Glower DD
        • Kar S
        • Trento A
        • Lim DS
        • Bajwa T
        • Quesada R
        • Whitlow PL
        • Rinaldi MJ
        • Grayburn P
        • Mack MJ
        • Mauri L
        • McCarthy PM
        • Feldman T
        Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study.
        J Am Coll Cardiol. 2014; 64: 172-181
        • Wan B
        • Rahnavardi M
        • Tian DH
        • Phan K
        • Munkholm-Larsen S
        • Bannon PG
        • Yan TD
        A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation.
        Ann Cardiothorac Surg. 2013; 2: 683-692
        • Maisano F
        • Franzen O
        • Baldus S
        • Schafer U
        • Hausleiter J
        • Butter C
        • Ussia GP
        • Sievert H
        • Richardt G
        • Widder JD
        • Moccetti T
        • Schillinger W
        Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe.
        J Am Coll Cardiol. 2013; 62: 1052-1061
        • Stone GW
        • Lindenfeld J
        • Abraham WT
        • Kar S
        • Lim DS
        • Mishell JM
        • Whisenant B
        • Grayburn PA
        • Rinaldi M
        • Kapadia SR
        • Rajagopal V
        • Sarembock IJ
        • Brieke A
        • Marx SO
        • Cohen DJ
        • Weissman NJ
        • Mack MJ
        Transcatheter mitral-valve repair in patients with heart failure.
        N Engl J Med. 2018; 379: 2307-2318
        • Alozie A
        • Paranskaya L
        • Westphal B
        • Kaminski A
        • Sherif M
        • Sindt M
        • Kische S
        • Schubert J
        • Diedrich D
        • Ince H
        • Steinhoff G
        • Oner A
        Clinical outcomes of conventional surgery versus MitraClip(R) therapy for moderate to severe symptomatic mitral valve regurgitation in the elderly population: an institutional experience.
        BMC Cardiovasc Disord. 2017; 17: 85
        • Taramasso M
        • Maisano F
        • Latib A
        • Denti P
        • Buzzatti N
        • Cioni M
        • La Canna G
        • Colombo A
        • Alfieri O
        Clinical outcomes of MitraClip for the treatment of functional mitral regurgitation.
        EuroIntervention. 2014; 10: 746-752
        • Detaint D
        • Sundt TM
        • Nkomo VT
        • Scott CG
        • Tajik AJ
        • Schaff HV
        • Enriquez-Sarano M
        Surgical correction of mitral regurgitation in the elderly: outcomes and recent improvements.
        Circulation. 2006; 114: 265-272
        • Kaneko H
        • Neuss M
        • Weissenborn J
        • Butter C
        Impact of residual mitral regurgitation after MitraClip implantation.
        Int J Cardiol. 2017; 227: 813-819
        • Neuss M
        • Schau T
        • Isotani A
        • Pilz M
        • Schopp M
        • Butter C
        Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure.
        JACC Cardiovasc Interv. 2017; 10: 931-939