Percutaneous mitral valve repair with the MitraClip system in the elderly: One-year outcomes from the GRASP registry. (1st December 2016) - Scandura, Salvatore
Abstract: Background: Although mitral regurgitation (MR) affects a relevant and increasing number of elderly, an optimal management of this high-risk population is challenging. Methods and results: The aim of this prospective, observational study was to compare one-year outcomes of MitraClip therapy in high surgical risk patients with moderate-to-severe or severe MR between patients aged < 75 versus ≥ 75 years. A total of 180 patients were included: 92 were < 75 years and 88 were ≥ 75 years old. At one-year follow-up the primary efficacy endpoint (composite of death, surgery for mitral valve dysfunction and grade 3 + or 4 + MR) occurred in 41 patients (24.5%), with similar rates between those aged < 75 years (23.9%) and those ≥ 75 years (25.2%), p = 0.912. A total of 21 (12.2%) deaths were observed within 1 year after the MitraClip procedure, without significant differences in cumulative mortality rates between elderly and younger patients (10.8% vs. 13.3%, respectively, p = 0.574). Compared with baseline, the significant reduction in MR severity achieved after the procedure was sustained at one-year follow-up, in both elderly and younger patients and a significant improvement in NYHA functional class was observed in both groups. A total of 18 (10.0%) patients experienced a re-hospitalization for acute heart failure within one-year after the MitraClip procedure, with no significant differences between elderly and younger. At one-year follow-up both elderly and younger patients showed significant reductions in left ventricular volumes, with changes of similar extent between the two subgroups. Conclusions: MitraClip therapy can be considered a viable option also among subsets with more advanced age.