WHAT IS A "GOOD" RESULT AFTER TRANSCATHETER MITRAL REPAIR? - - PowerPoint PPT Presentation

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WHAT IS A "GOOD" RESULT AFTER TRANSCATHETER MITRAL REPAIR? - - PowerPoint PPT Presentation

Oct 24, 2023 284 likes •426 views

WHAT IS A "GOOD" RESULT AFTER TRANSCATHETER MITRAL REPAIR? IMPACT OF 2+ RESIDUAL MITRAL REGURGITATION Nicola Buzzatti MD 1 , Paolo Denti MD 1 , Michele De Bonis MD 1 , Fabio Barili MD 2 , Davide Schiavi 1 , Giovanna Di Giannuario MD 1 ,

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WHAT IS A "GOOD" RESULT AFTER TRANSCATHETER MITRAL REPAIR? IMPACT OF 2+ RESIDUAL MITRAL REGURGITATION

Nicola Buzzatti MD1, Paolo Denti MD1, Michele De Bonis MD1, Fabio Barili MD2, Davide Schiavi1, Giovanna Di Giannuario MD1, Giovanni La Canna MD1, Ottavio Alfieri MD1.

1Cardiac Surgery Department, San Raffaele Scientific Institute, Milan Italy 2 Cardiac Surgery Department, Santa Croce Hospital, Cuneo Italy

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Disclosures

  • None
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Background

ACCESS-EU Registry, Maisano et al, JACC 2013 Grigioni et al, Circulation 2001 De Bonis et al, JTCVS 2012

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Methods

  • OSR MitraClip patients’ pathway:

– Anatomy selection by TOE – Risk selection and overall judgment by Heart-Team approach – Standardized prospective in-hospital data collection – Enrollement in a dedicated follow-up out-patient clinic

  • MR grading according to EACTS/ESC Guidelines: 1+ mild, 2+ moderate, 3+ medium, 4+

severe 243 consecutive symptomatic high-risk patients from October 2008 to December 2014 Acute residual MR ≤2+ n=223 (91.8%) Acute residual MR ≥3+ n=20 (8.2%) Residual MR ≤1+ n=159 (65.4%) Residual MR 2+ n=64 (26.4%) Excluded from the study Study group

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Baseline clinical features

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Baseline echo features

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Follow-up results

Follow-up 100% complete Median follow-up time 20.5 months (IQR 8-36 up to 75 months)

  • 30-day mortality 4/223 (1.8%)
  • Overall follow-up survival 50.4 ±7.5% at 56

months

  • Cardiac death

– 27/46 (58.7%) in FMR group – 3/15 (20.0%) in DMR group

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Freedom from cardiac death in FMR

28 48.4 ± 10.2% 88.9 ± 3.6%

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Follow-up NYHA class in FMR

p=0.002 Paired data from 141 (91.0%) patients * In DMR, NYHA III was found in only 3 of 2+MR vs 4 of ≤1+MR patients (p=0.47)

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MR ≥ 3+ RECURRENCE

Residual 2+ was the only independent predictor of MR recurrence: p<0.001, HR 8.3 (CI 3.6-19.5) p=0.005, HR 5.5 (CI 1.6-18.3) 48.2 ± 9.4% 94.7 ± 2.3% 9 68.0 ±10.9% 92.8 ± 4.0% FMR DMR

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Is it only a matter of severe MR recurrence? Does 2+MR per se have an impact?

71.2±1.1 95.6±2.1

Multivariable COX prediction for cardiac death (n=127) p value HR CI Age 0.026 1.07 1.01-1.13 Pre-op LVEDD 0.001 1.19 1.08-1.31 Pre-op sPAP 0.021 1.05 1.01-1.09 Residual 2+MR 0.038 3.31 1.07-10.20

p=0.045

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Study limitations

  • Small numbers
  • Short follow-up
  • Single centre
  • Learning curve?
  • MR quantification in the double-orifice setting

remains challenging

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Conclusions

  • Residual 2+MR was associated with increased early MR recurrence

in both FMR and DMR

  • In FMR it also predicted reduced mid-term survival and worse

symtoms

  • Reduction of MR to 2+ MAY still be acceptable is some high-risk

patients with short life expectancy?

– Which 2+MR will remain stable? – Which 2+MR will get worse?

  • Better efficacy should be achieved be transcatheter mitral repair

technologies before expanding indications to mid/low-risk patients