Abstract 17352: Functional, Quality-of-Life and Echocardiographic Parameters at 2 Years after Successful Mitraclip Therapy in Patients Not Amenable to Surgery
Background and objective. MitraClip implantation is an evolving therapeutic alternative to surgery for patients with significant mitral regurgitation (MR) but there is still a paucity of long-term data. In patients deemed not amenable to surgery, we assessed changes from baseline to 24 months after MitraClip in clinical and echocardiographic variables.
Methods and results. Of 311 consecutive patients with significant MR who have undergone MitraClip therapy at our center since September 2008, 2-year follow-up (FU) was due by July 1, 2012, in 144 patients of whom 133 (92%) were treated successfully (discharge MR ≤2+). Forty-one (31%) of the 133 patients had died before FU. Of the 92 surviving patients, 83 (74 ± 9 years; 52 men; 57 [69%] functional MR) were followed clinically for a median of 23.8 [IQR, 22.1 - 24.9] months. NYHA functional class at baseline was II, III and IV in 1, 51 and 31 (37%) patients, respectively. At FU, NYHA class had improved in 59 patients (71%), with 47 patients (57%) in NYHA class I or II. No change vs. baseline was seen in 21 patients and 3 patients had clinically worsened. Six-minute walk distance assessed in 42 matched patients had improved from a median of 195 m to 300 m (P = 0.0027) and quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire in 56 patients had improved from a median score of 38 to 32 (P = 0.0016). MR severity assessed in 76 patients had improved at FU by at least 1 grade in all patients but 3; with baseline MR 3+ and 4+ in 39 and 37 patients, respectively, MR grade at FU was 1+ (n=18) or 2+ (n=51) in a total of 69 patients (91%). Statistically significant reductions vs. baseline were observed for LV end-diastolic volume (LVEDV) (median 180 ml vs. 204 ml [n=52; median relative decrease by 11.0%]; P = 0.0033) and LV ejection fraction (n=52; median 39% vs. 47% [median relative decrease by 9.1%]; P = 0.0003), but not for LV end-systolic volume (median 112 ml vs. 115 ml; P = 0.319). Forward stroke volume (FSV) (n=51) had increased significantly by 30.3% from a median of 45 ml to 57 ml (P = 0.0003).
Conclusions. After successful MitraClip therapy, marked functional and quality-of-life improvement is apparent in the majority of patients surviving out to 2 years. Reduced MR severity is sustained, LVEDV decreases and FSV increases.
- © 2012 by American Heart Association, Inc.