Percutaneous treatment of mitral regurgitation in patients with impaired ventricular function: Impact of intracardiac electronic devices (from the German Transcatheter Mitral Valve Interventions Registry). Issue 5 (21st February 2019)

• Record Type: Journal Article
• Authors: D'Ancona, Giuseppe; Ince, Hüseyin; Schillinger, Wolfgang; Senges, Jochen; Ouarrak, Taoufik; Butter, Christian; Seifert, Martin; Schau, Thomas; Lubos, Edith; Boekstegers, Peter; von Bardeleben, Ralph Stephan; Safak, Erdal
• Is Part Of: Catheterization and cardiovascular interventions. Volume 94:Issue 5(2019)
• Page Start: 755
• Page End: 763
• Publication Date: 2019-02-21
• Subjects: CRT -- failure -- heart -- ICD -- MitraClip; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28127
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: To identify prevalence/impact of previous implantation of cardiac electronic devices (CEDs), such as cardioverter defibrillator (ICD) and cardiac resynchronization (CRT), in a group of MitraClip (MC) candidates with LVEF < 30%. Background: MC therapy is nowadays often considered in patients with depressed left ventricular ejection fraction (LVEF%) and symptomatic severe secondary MR. Methods: Data from the German Transcatheter Mitral Valve Interventions (TRAMIs) registry were analyzed. Patients with pre‐procedural LVEF <30% were selected and divided according to the presence of CEDs. Pre‐procedural, peri‐procedural, and 1‐year follow‐up data were analyzed. Results: Out of 689 MC patients, 235 had LVEF<30%. Of these, 23% (54/235) had CRT, 36.6% (86/235) ICD, and 40.4% (95/235) had no CEDs. Risk profile was similar (median STS score CRT 6.0 (IQR: 3.0–12.0); ICD 7.0 (IQR: 4.0–12.0); No‐CED 6.5 (IQR: 2.0–10.0); p = 0.8). No procedural mortality was observed and hospital mortality was 5.6% in CRT, 2.3% in ICD, and 3.2% in No‐CED ( p = 0.5). At discharge, severe MV regurgitation was reported in 3.8% of CRT, 3.7% of ICD, and 1.1% of No‐CED ( p = 0.9). One year estimated survival (CRT 75.7%; ICD 75.8%; No‐CED 78%; p = 0.94) and freedom from MACCE (CRT 73.6%; ICD 75.8%; No‐CED 74.5%; p = 0.88) were similar. Conclusions: A third of patients have been already submitted to CEDs implantation at time of referral for MC therapy and 40% of those with severely depressed LVEF% arrive to MC therapy before ICD/CRT implantation. The presence of CED does not impair acute MC therapy success. Mid‐term follow‐up outcomes are similar in patients with and without CEDs.