Echocardiographic and Clinical Outcomes of Central Versus Noncentral Percutaneous Edge-to-Edge Repair of Degenerative Mitral Regurgitation

• Published in: Journal of the American College of Cardiology Vol. 62; no. 25; pp. 2370 - 2377
• Main Authors: Estévez-Loureiro, Rodrigo, MD, PhD, Franzen, Olaf, MD, Winter, Reidar, MD, PhD, Sondergaard, Lars, MDSc, Jacobsen, Per, MD, Cheung, Gary, MD, Moat, Neil, MS, Ihlemann, Nikolaj, PhD, Ghione, Matteo, MD, Price, Susanna, MD, PhD, Duncan, Alison, MD, Streit Rosenberg, Tine, RN, Barker, Sarah, MSc, Di Mario, Carlo, MD, PhD, Settergren, Magnus, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 24.12.2013; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; catheter-based-therapy; Catheterization, Central Venous - methods; Chronic obstructive pulmonary disease; Echocardiography, Transesophageal - methods; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart attacks; Heart Valve Prosthesis Implantation - methods; heart valves; Hospitalization; Humans; Internal Medicine; Intervention; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Kardiologi; Klinisk medicin; Male; Medical sciences; Medicin och hälsovetenskap; mitral regurgitation; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Mortality; Pathology; Pulmonary arteries; Radiologi och bildbehandling; Retrospective Studies; Surgery; Survival analysis; Treatment Outcome; Ultrasonic investigative techniques; NYHA; mitral regurgitation; MR; degenerative mitral regurgitation; dMR; MV; LV; 2-dimensional; 3D; New York Heart Association; 2D; heart valves; TEE; mitral valve; transesophageal echocardiography; catheter-based-therapy; left ventricular; 3-dimensional; Sonography; Corrective surgery; Mitral valve; Echocardiography; Prognosis; Cardiovascular disease; Percutaneous route; Treatment; Cardiac valvular disease; Mitral regurgitation; Evolution; Circulatory system; Cardiology; Repair; Edge; Comparative study
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2013.05.093

Objectives This study aimed to assess the clinical and echocardiographic results of MitraClip implantation in noncentral degenerative mitral regurgitation (dMR) compared with central dMR. Background It is unknown whether the use of MitraClip therapy in noncentral dMR is as safe and effective as in central dMR. Methods We analyzed a multicenter registry of 173 patients treated with the MitraClip and compared results of central and noncentral dMR. Results Seventy-nine patients (age 79.2 ± 8.0 years, 58.2% men) had dMR. Forty-nine patients (62%) had central dMR, with the remainder classified as noncentral dMR (n = 30, 38%). Patients with noncentral dMR had a wider pre-procedural vena contracta (8.5 ± 2.0 mm vs. 6.9 ± 2.2 mm, p = 0.039) and higher systolic pulmonary pressure (57.9 ± 18.0 vs. 47.3 ± 13.0 mm Hg, p = 0.019). Procedural success was the same in both groups (95.5% central vs. 96.7% noncentral, p = 0.866). Post-procedural MR and New York Heart Association (NYHA) functional class at 1 month (MR ≤2, 96.0% vs. 96.6%, p = 0.866, and NYHA functional class ≤II, 81.6% vs. 90.0%, p = 0.335) and 6 months (95.2% central vs. 91.7% noncentral, p = 0.679; and NYHA functional class >II, 21.1% vs. 0%, p = 0.128) did not differ between groups. There were also no differences in serious post-procedural adverse events: partial clip detachment (central n = 1 [2.0%] vs. noncentral n = 1 [3.3%], p = 1.000), death (5.4% central vs. 13.0% noncentral, p = 0.298), or heart failure admission (10.8% central vs. 8.7% noncentral, p = 0.791). Conclusions In experienced centers, MitraClip treatment can be performed safely and effectively in both central and noncentral dMR.