Mitraclip Procedure In The Hands Of Cardiac Surgeon. Short-term Results Of 1 Year Self-experience
Krystian Jakimowicz, Grzegorz Hirnle, Witold Bratkowski, Tomasz Niklewski, Michał Zembala, Zbigniew Kalarus, Mariusz Gąsior.
The Silesian Center for Heart Diseases in Zabrze, Zabrze, Poland.
Objective: The MitraClip system is a percutaneous device dedicated for repair or reduction of mitral valve regurgitation (MR) in patients with heart failure (HF) and high surgical risk. All over the world this procedure is mostly performed by cardiologists due to their everyday experience with transseptal puncture and working without direct visualization of the heart. Open-heart surgery experience is extremely helpful in enriching surgical portfolio with new skills and technologies. Cardiac surgeons can perform MV repair using MitraClip device safely and effectively.
Methods: This prospective, observational, non-randomized study assessed the results of mitral valve reconstruction using MitraClip device. Using transthoracic echocardiography (TTE) residual level of MR at 6 months follow-up was determined.
Results: Between December 2018 and October 2019, 11 patients were enrolled. Mean age was 62,1 years, 81.8% (n=9) patients were men. Severe MR was present in 72.7% (n=8) patients, 27.3% (n=3) patients had moderate-to-severe MR. 100% (n=11) of patients were in New York Heart Association (NYHA) Class III or IV before the procedure. The cause of MR in 81.8% (n=9) patients was ischemic cardiomyopathy, in 27.3% (n=3) MR was present due to leaflet prolapse. The mean ejection fraction of the left ventricle was 28,7%. The implantation of MitraClip was successful in all patients. 1 patient (9%) had intraoperative vascular complication. Postprocedural TTE showed whether none or mild MR in 7 patients (63.6%), mild/moderate in 1 patient (9.1%) and moderate in 3 patients (27.3%). 1 (9%) patient after 3 weeks underwent heart transplant procedure. 6 months after the procedure 90.9% (n=10) patients are in NYHA Class I or deny any dyspnea and none of them was hospitalized due to heart failure exacerbation.
Conclusion: MitraClip device is safe and effective for repair and reduction of clinically significant MR. Study shows that this challenging percutaneous procedure is not devoid of potential complications among which some may require an urgent surgical intervention. Mitral valve reconstruction using MitraClip device in the hands of cardiac surgeon shows very promising results. Further investigation is needed to determine long-term results and potential benefits in this group of patients.
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