Mitraclip Implantation In A Surgical Department As First Line Treatment Alternatively To Assist Device Implantation
Simon H. Sündermann, Karel Van Praet, Marian Kukucka, Alexander Meyer, Felix Schönrath, Jan Knierim, Stephan Jacobs, Volkmar Falk, Jörg Kempfert.
Deutsches Herzzentrum Berlin, Berlin, Germany.
OBJECTIVE: Mitraclip implantation has become a widely accepted alternative treatment option for patients with severe mitral valve regurgitation and high calculated periopterative risk. In this study we assessed the value of Mitraclip interventions in a high risk surgical patient population with heart failure, evaluated for heart transplantation and/or assist device implantation.
METHODS: Between December 2014 and July 2016, 49 patients underwent Mitraclip implantation in our surgical department. The patients had high calculated perioperative risks and functional mitral valve insufficiency (MR) with severely decreased left ventricular LV function. Retrospective data analysis of the prospectively collected data was performed.
RESULTS: Mean age of the patients was 66±7 years. 61% were male. All patients were at least at NYHA stadium III. Mean logistic EuroSCORE was 26±17%, mean EuroSCORE II was 10±8% and mean STSPROM was 4±4%. Mean left ventricular ejection fraction was 27±12%. Mean LVEDD was 57±10mm. Mean sphericity index of the left ventricle was 0.8±0.2. Mean procedure time was 122±46min. Most patients (33) had implantation of two clips. Reduction of MR of at least two grades could be achieved in all patients. One patient had a major complication (pericardial effusion), 1 patient died within 30 days. 6 further patients died during followup. 4 patients (8%) had LVAD implantation. One patient after one and a half years after the Mitraclip procedure and three patients within 6 months after the implantation. KaplanMeier estimated survival at one year was 72,5%.
CONCLUSIONS: Mitraclip implantation in patients evaluated for assist device implantation and/or heart transplantation is a safe alternative option for potential bridging. Future challenge will be to define independent predictors to identify nonresponders.
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