MIDA mortality risk score in patients undergoing percutaneous edge-to-edge mitral repair. (25th November 2020)

• Record Type: Journal Article
• Authors: Kavsur, R; Iliadis, C; Metze, C; Spieker, M; Tiyerili, V; Horn, P; Baldus, S; Kelm, M; Nickenig, G; Pfister, R; Westenfeld, R; Becher, M.U
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Valvular Heart Disease: Intervention; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.1965
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR). Aim: We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure. Methods: In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation. Results: During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p<0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029). Conclusion: The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients. Funding Acknowledgement: Type of funding source: None