Percutaneous mitral valve repair: The last chance for symptoms improvement in advanced refractory chronic heart failure?. (1st February 2017)

• Record Type: Journal Article
• Authors: Berardini, Alessandra; Biagini, Elena; Saia, Francesco; Stolfo, Davide; Previtali, Mario; Grigioni, Francesco; Pinamonti, Bruno; Crimi, Gabriele; Salvi, Alessandro; Ferrario, Maurizio; De Luca, Antonio; Gazzoli, Fabrizio; Bacchi Reggiani, Maria Letizia; Raineri, Claudia; Sinagra, Gianfranco; Rapezzi, Claudio
• Is Part Of: International journal of cardiology. Volume 228(2017)
• Page Start: 191
• Page End: 197
• Publication Date: 2017-02-01
• Subjects: Mitral regurgitation -- Heart failure -- Percutaneous mitral valve repair -- Remodeling; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.11.241
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear. Methods: Seventy-five consecutive patients with FMR grade ≥ 3 + and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month. Results: Mean age was 67 ± 11 years, logistic EuroSCORE = 23 ± 18%, left ventricle ejection fraction (LVEF) 30 ± 9%. In 6 patients (8%) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3% (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84%) were discharged with MR ≤ 2 +. At 6-month, 4 patients died (5%), 80% had MR ≤ 2 + and 75% were in New York Heart Association class ≤ II. Median pro-BNP decreased from 4395 pg/ml to 2594 pg/ml ( p = 0.04). There were no significant changes in LV end-diastolic volume (222 ± 75 ml vs. 217 ± 79, p = 0.19), end-systolic volume (LVESV, 154 ± 66 ml vs. 156 ± 69, p = 0.54) and LVEF (30 ± 9% vs. 30 ± 12%, p = 0.86). Significant reverse remodeling (reduction of LVESV ≥ 10%) was observed in 25%, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6 months before PMVR were reduced from 1.1 ± 0.8 to 0.3 ± 0.6 ( p < 0.001). Conclusions: In extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6 months, despite the lack of LV reverse remodeling.