Outcomes After the MitraClip Procedure in Patients at Very High Risk for Conventional Mitral Valve Surgery.

Autor:	Manghelli JL; From the Divisions of Cardiothoracic Surgery and., Carter DI; From the Divisions of Cardiothoracic Surgery and., Khiabani AJ; From the Divisions of Cardiothoracic Surgery and., Maniar HS; From the Divisions of Cardiothoracic Surgery and., Damiano RJ Jr; From the Divisions of Cardiothoracic Surgery and., Sintek MA; Cardiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO USA., Lasala JM; Cardiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO USA., Zajarias A; Cardiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO USA., Melby SJ; From the Divisions of Cardiothoracic Surgery and.
Jazyk:	angličtina
Zdroj:	Innovations (Philadelphia, Pa.) [Innovations (Phila)] 2018 Nov/Dec; Vol. 13 (6), pp. 433-437.
DOI:	10.1097/IMI.0000000000000571
Abstrakt:	Objective: Approximately 50% of patients with severe symptomatic mitral regurgitation are deemed too high risk for surgery. The MitraClip procedure is a viable option for this population. Our goal was to assess outcomes and survival of patients who underwent the MitraClip procedure at an institution where mitral valve surgery is routinely performed. Methods: A retrospective study of patients undergoing the MitraClip procedure was performed. Baseline characteristics, perioperative outcomes, and follow-up echocardiographic and clinical outcomes were examined. Primary end point was survival. Secondary end points included technical failure (residual 3/4+ mitral regurgitation), reoperation, New York Heart Association symptoms, 30-day mortality, and other clinical outcomes. Predictors of mortality were determined using multivariable regression analysis. Results: Fifty consecutive patients underwent the MitraClip procedure during the 4-year period. The average age was 83, the Society of Thoracic Surgeons predicted risk of mortality mean was 9.4%, 88% (44/50) had New York Heart Association III/IV symptoms, 86% (43/50) had 4+ mitral regurgitation, and 72% (36/50) had degenerative mitral disease etiology. Echocardiographic data (median [interquartile range] follow-up = 43 [26-392]) showed that 86% (43/50) of patients had 2+ or less mitral regurgitation. Sixty percent (24/40) had New York Heart Association I/II symptoms at last follow-up. Predictors of mortality were higher Society of Thoracic Surgeons predicted risk of mortality (P = 0.042, hazard ratio = 1.098) and previous cardiac surgery (P = 0.013, hazard ratio = 3.848). Survival at 1 and 2 years was 75% and 63%, respectively. Conclusions: Many patients with mitral valve regurgitation who are high risk for open surgery can be treated with the MitraClip procedure. In our study, most patients (86%) had a technically successful operation and postoperative outcomes including survival were acceptable.
Databáze:	MEDLINE
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