Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip
2014 | journal article; research paper. A publication with affiliation to the University of Göttingen.
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Puls, M., Tichelbäcker, T., Bleckmann, A., Huenlich, M., von der Ehe, K., Beuthner, B. E., Rueter, K. ... Schillinger, W. (2014). Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip. EuroIntervention, 9(12), 1407-1417. doi: https://doi.org/10.4244/EIJV9I12A238
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- Authors
- Puls, Miriam ; Tichelbäcker, Tobias ; Bleckmann, Annalen ; Huenlich, Mark ; von der Ehe, Katrin; Beuthner, Bo Eric; Rueter, Karin; Beißbarth, Tim ; Seipelt, Ralf; Schoendube, Friedrich ; Hasenfuß, Gerd ; Schillinger, Wolfgang
- Abstract
- Aims: MitraClip implantation is evolving as a potential alternative treatment to conventional surgery in high-risk patients with significant mitral regurgitation (MR). However, outcome predictors are under-investigated. The aim of this study was to identify predictors of midterm mortality and heart failure rehospitalisation after percutaneous mitral valve repair with MitraClip. Methods and results: A total of 150 consecutive patients were followed for a median of 463 days. Survival analyses were performed for baseline characteristics, risk scores and failure of acute procedural success (APS) defined as persisting MR grade 3+ or 4+. Univariate significant risk stratifiers were tested in multivariate analyses using a Cox proportional hazards model. Overall survival was 96% at 30 days, 79.5% at 12 months, and 62% at two years. Multivariate analysis identified APS failure (HR 2.13, p=0.02), NYHA Class IV at baseline (HR 2.11, p=0.01) and STS score >= 12 (HR 2.20, p<0.0001) as significant independent predictors of all-cause mortality, and APS failure (HR 2.31, p=0.01) and NYHA Class IV at baseline (HR 1.89, p=0.03) as significant independent predictors of heart failure rehospitalisation. Furthermore, a post-procedural significant decrease in hospitalisation rate could only be observed after successful interventions (0.89 +/- 1.07 per year before vs. 0.54 +/- 0.96 after implantation, p=0.01). Patients with severely dilated and overloaded ventricles who did not meet EVEREST II eligibility criteria were at higher risk of APS failure. Conclusions: The failure of acute procedural success proved to have the most important impact on outcome after MitraClip implantation.
- Issue Date
- 2014
- Publisher
- Europa Edition
- Journal
- EuroIntervention
- ISSN
- 1774-024X
- eISSN
- 1969-6213