14. Prince Sultan Cardiac Center experience on mitral clip (What is new?)

• Published in: Journal Of The Saudi Heart Association Vol. 27; no. 4; pp. 304 - 305
• Main Authors: Osman, Hatim Khieralla, Samargandy, Sondos Ahmad
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.10.2015; Saudi Heart Association
• ISSN: 1016-7315; 2212-5043
• DOI: 10.1016/j.jsha.2015.05.195

•Total number of patients: 33•22 males (63.6%)+12 females (36.6%)•Age (min 43 & max 92 with mean 66.82−SD 12.5)•Etiology:•Functional ischemic=13 (39.3%)•Degenerative=4 (12.12)•Flail AML/ISCHEMIC=1 (3%)•Functional non ischemic=15 (45.45%) 1.EF-have increased after the intervention in all periods of monitoring time, however it was only statistically significant at 6th month using t-test with p-value=0.024. Moreover, assuming that the distribution is not normal, using Wilcoxon Signed Ranked Test, out of 10 people in sixth month, 5 have positively increased EF and the other 5 remains the same with a z-value=−2.121, p-value=0.034.2.PASP – Due to the attrition rate, only comparisons up to sixth months can be fairly interpreted. The results shows that on the sixth month monitoring, PASP all decreased at a certain level but only statistically significant at the first day using Paired t-test, with p-value=0.015. Again assuming that the distribution is not Gaussian, Wilcoxon Signed Ranked test shows that out of 22 patients, 14 (63.64%) had decreased PASP, 4 (18.18%) have increased and 4 (18.18%) remains the same with z-value=−2.379, p-value=0.0173.MR improvement:∘No change (remained sever)=6 patients (2 degenarative, 3 functional, 1 ischemic) 18.18%∘One degree improvement (severe to mod)=18 (54.5%)∘Two degrees improvement (sever to mild)=5 (15.15%)∘Three degrees (sever to non/residual)=1(3%)∘Shifted to MVR from table=2 (6%)∘Aborted on table=1 (3%)4.Complications related directly to the procedure or later on:•Aborted on table due to pericardial effusion during the intra-atrial septal puncture=1 (3%)•Shifted to MVR as emergency due to technical problems during the procedure=2 (6%)•Shifted to MVR after a year due to sever MS (sever fibrotic reaction to the clip)=1 (3%)•Twice clipped=2 (6%) (one on same setting with good result & the other on 2 different setting with no good result/sever MR remained)•Death in 1st 6/12 post procedure (out side hospital)=1 (3%)•2 attempts for same patient, 1st one was aborted before the puncture due to huge LA & 2nd time was successful=1 (3%)…. Same patient developed CVA after 30days Post procedure/Back round Hx of AF & warfarin incomplaince•Siezure with in 1st 24h post procedure (clip attached to PML alone). Family declined high risk surgery & continue on medical therapy)=1(3%)•Heart failure/pleural effusion with in 3months post procedure (although MR improved from sever to trace)=1 (3%)•Recurrent ER visits for Heart failure (no improvement in MR. Sever with multiple jets)•Vascular complication (femoral hematoma & throat hematoma) treated conservatively=1 (3%)•Acute on chronic renal failure (contrast induced nephropathy)-recovered later on=1 (3%) It was noticed: elderly (92years old) had many complications) : Flail AML, twice clip, vascular complication & contrast induced nephropathy. Elderly female (80+years): clip was attached only to PML & developed seizure within 24h post procedure. The small number of patients, the relatively short duration of follow up and the drop out of few patients are counted as shortcomings in the data analysis and the generalizability of the conclusions drawn. We nevertheless hope to add our humble contribution to the already fast growing data worldwide.