Outcome comparison of mitral valve surgery and MitraClip therapy in patients with severely reduced left ventricular dysfunction.

Autor: Gyoten T; Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Schenk S; Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Rochor K; Department of Cardiology, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Herwig V; Department of Cardiology, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Harnath A; Department of Cardiology, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Grimmig O; Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Just S; Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Fritzsche D; Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany., Messroghli D; Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.; Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.; German Center for Cardiovascular Research (DZHK), partner site, Berlin, Germany.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2020 Aug; Vol. 7 (4), pp. 1781-1790. Date of Electronic Publication: 2020 May 23.
DOI: 10.1002/ehf2.12741
Abstrakt: Aims: The aim of this study was to compare the outcomes of surgical mitral valve repair or replacement (sMVR) and percutaneous edge-to-edge repair using MitraClip (pMVR) in patients with severe left ventricular dysfunction affected by functional mitral regurgitation (FMR).
Methods and Results: We retrospectively identified 132 patients with left ventricular ejection fraction (LVEF) ≦ 30% submitted to sMVR (n = 47) or pMVR (n = 85) for FMR at our centre from January 2013 to December 2017. To adjust for baseline imbalances, we used a propensity score matching by age, logistic EuroSCORE, and left ventricular end-systolic volume. After being matched, MitraClip therapy showed lower perioperative mortality and rate of complications yet increased residual mitral regurgitation (MR) grade than did surgery (0.2 ± 0.50 in sMVR vs. 1.3 ± 0.88 in pMVR, P < 0.0001). According to stratified multivariate Cox model analysis, residual MR severity was an independent risk factor for cardiac death [hazard ratio (HR), 2.81; 95% confidence interval [CI], 1.44-5.48, P = 0.0025] and re-hospitalization for heart failure (HR, 3.07; 95% CI, 1.50-6.29, P = 0.0022) at 1 year follow-up. Stratified multivariable Cox regression analysis at 3 years identified pMVR as risk factor for cardiac death (HR, 0.19; 95% CI, 0.040-0.86, P = 0.031) and re-hospitalization for heart failure (HR, 0.28; 95% CI, 0.077-0.99, P = 0.048).
Conclusions: In patients with FMR and LVEF ≤ 30%, MitraClip therapy resulted in lower perioperative complications and mortality than sMVR. However, surgically treated patients who survived the perioperative stage had less residual MR and experienced lower rates of re-hospitalization for heart failure at 1 year and lower cardiac mortality at 1 and 3 years of follow-up than did patients undergoing pMVR.
(© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)
Databáze: MEDLINE
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