Abstract 12054: Unmet Need and Applicability of Transcatheter Mitral Valve Repair with MitraClip in Patients with Severe Symptomatic Mitral Regurgitation
Background: Patients with severe symptomatic mitral regurgitation (MR) have poor outcome without mitral valve (MV) surgery. Transcatheter MV repair using MitraClip is emerging as an alternative option.
Aims: We sought to assess the characteristics of patients with severe symptomatic MR who do not undergo MV surgery, the unmet need for MitraClip therapy and its applicability in this population.
Methods: From our echocardiography database and electronic patient medical records, 1095 patients with severe (≥3+) symptomatic (NYHA class ≥2) MR were identified between 2000 and 2008. Clinical characteristics were compared between patients who did and did not have MV surgery. Echocardiograms of patients not undergoing MV surgery were reviewed for eligibility for MitraClip.
Results: MV surgery was performed in 518 (47%) patients. Unoperated patients had lower ejection fraction (EF) (27±15% vs. 42±17%, p<0.0001) and more co-morbidities as indicated by a higher STS score (10±32 vs 6.5±8.5, p<0.001) compared to operated patients. Functional MR (FMR) was the etiology in 74% of patients in the overall cohort, and 90% of the unoperated cohort. When stratified by EF, unoperated patients with EF >40% were older and had higher STS score when compared to those who underwent MV surgery (Table). In contrast, unoperated patients with EF≤40% had similar STS score compared to operated patients. Out of 474 unoperated patients with symptomatic severe FMR, 171 (36%) patients were eligible for MitraClip based on anatomic and functional echocardiographic criteria.
Conclusion: Almost one-half of patients with severe symptomatic MR do not undergo MV surgery, indicating a huge unmet need for transcatheter MV repair. Preoperative risk of mortality with MV surgery as assessed by STS score was different in operated and unoperated patients with EF>40%, but not in those with EF≤40%. Greater than a third of unoperated FMR patients are eligible for MitraClip therapy based on echocardiographic criteria.
- © 2012 by American Heart Association, Inc.