Abstract 15961: Clinical Outcomes of Mitraclip Therapy for Functional Mitral Regurgitation in High-Risk Patients: A Comparison With a Large Surgical Series
OBJECTIVES: Mitraclip is an emerging option for selected high risk patients with functional mitral regurgitation (FMR). The aim of this study is to compare the outcomes of patients who underwent surgical mitral repair and Mitraclip therapy for FMR in our experience.
METHODS: From March 2000, 143 patients with FMR were treated in our Institution: 91 patients (63.6%) underwent surgical mitral repair (49% ischemic; 51% dilatative) and 52 patients (36.4%) underwent Mitraclip implantation (71% ischemic; 29% dilatative). Associate procedures in surgical group were myocardial revascularization in 35%, tricuspid repair in 25% and atrial fibrillation ablation in 26%. Follow-up was 100% complete (29.2±30.1 months for surgery and 9.6±7.7 months for Mitraclip).
RESULTS: Mitraclip patients were older (p=0.04), had higher Log-EuroScore (p<0.0001), lower LVEF (p=0.006) and higher LV diameter (p=0.01 for LVEDD and p=0.05 for LVESD). Postoperative major infection or sepsis occurrence was higher in surgical group (16.3% Vs 3.8% p=0.01), while no differences were observed in terms of acute renal failure, cardiogenic shock, cerebrovascular accident and acute myocardial infarction. Length-of-stay was longer for surgery (15.8±15.1 days for surgery; 9.5±16.3 days for Mitraclip -p=0.02). In-hospital mortality was 6.6% for surgery (6/91) and 0% for Mitraclip (p=0.01). Surgery was identified as predictor of in-hospital death (OR 2.61; p=0.01). Residual MR≥2+ at discharge was 8.3% for surgery and 28.6% for Mitraclip (p=0.002). At follow-up, actuarial survival at 1 year was 88.9±3.5% for surgery and 90.3±6.6% for Mitraclip (p=0.3). At last follow-up, most of the survivors were in NYHA class I-II and recurrent MR≥2+ was 40.9% for Mitraclip and 25.3% for surgery (p=0.06).
CONCLUSIONS: Mitraclip therapy is a safe therapeutic option in selected high-risk patients with FMR and it is associated with lower hospital mortality and shorter length-of-stay compared to surgery, in spite of worse preoperative conditions. However, residual MR is higher with Mitraclip and further studies are needed to determine the long-term clinical impact.
- © 2011 by American Heart Association, Inc.