Patient selection criteria and midterm clinical outcome for MitraClip therapy in patients with severe mitral regurgitation and severe congestive heart failure

European Journal of Heart Failure - Tập 15 Số 7 - Trang 786-795 - 2013
Michael Neuß1, Thomas Schau1, M. Schoepp1, Martin Seifert1, Frank Hölschermann1, Jürgen Meyhöfer1, Christian Butter1
1Heart Center Brandenburg in Bernau Ladeburger Straße 17, D‐16321 Bernau Germany

Tóm tắt

AimsThe implantation of a MitraClip (MC) is a new treatment modality for severe mitral regurgitation (MR) in patients whose condition is inoperable or who are at high conventional operative risk. This study reports the follow‐up data of patients implanted with an MC in our heart centre to find selection criteria for this procedure in patients with severe congestive heart failure.Methods and resultsThis study included 163 implantation procedures in 157 patients between March 2009 and November 2012. The severe MR was caused by functional or organic valve disease. The patients had no surgical treatment option or dramatically increased surgical operative risk due to reduced LVEF or concomitant diseases. Three (2%) implantation procedures were unsuccessful. Eleven (7%) patients died during the first 30 days after MC implantation, and 9 (6%) additional patients died during the first 6 months, both groups mainly due to severe, therapy‐resistant end‐stage heart failure. The 111 patients who were followed up showed significant improvement in NT‐proBNP, LVEF, NYHA class, 6 min walk test, and quality of life. Ten (6%) patients needed conventional heart surgery despite high operative risk due to persistent symptomatic MR after MC implantation.ConclusionThe interventional implantation of an MC is a new treatment for severe MR with acceptable periprocedural risk and results in clinical improvement in the majority. Patients with end‐stage heart failure and an NT‐proBNP value >10 000 pg/mL have a high mortality despite MC implantation, and their treatment should be based on a very individualized decision. Based on this experience, a clinical algorithm for patient selection is proposed.

Từ khóa


Tài liệu tham khảo

10.1016/j.jacc.2005.07.065

10.1002/ccd.20917

10.4244/EIJV4I4A76

10.1016/j.jacc.2009.03.077

10.1056/NEJMoa1009355

10.1016/j.jacc.2010.11.043

10.1093/eurheartj/ehq051

10.1093/eurjhf/hfr141

Bonow RO, ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons, Circulation 2006, 114, e84

10.1093/eurheartj/ehm095

10.1093/eurheartj/ehq050

10.1093/eurjhf/hfr029

10.1007/BF03091811

10.1016/j.amjcard.2011.06.069

10.1016/j.jacc.2011.07.047

10.1093/eurjhf/hfs079

10.1093/eurjhf/hfr038

10.1016/S0894-7317(03)00335-3

10.1016/j.amjcard.2007.06.066

Rector TS, Validity of the Minnesota Living With Heart Failure Questionnaire as a measure of therapeutic response to enalapril or placebo, Am J Cardiol, 13, 1106

10.1093/eurjhf/hfs069

Thông tin
Thông tin xuất bản

European Journal of Heart Failure

Tập 15 Số 7

786-795

Thông tin tác giả