Abstract 13223: Short-term Mortality After MitraClip or Mitral Valve Surgery in Patients at High Risk for Surgical Mortality
Background: The optimal treatment of patients with severe mitral regurgitation (MR) in patients at high surgical risk (HSR) is unknown. Recently, the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study suggested MitraClip (MC) was safe and effective treatment option
Methods: We performed a search strategy for MC or MVS in patients at HSR for surgical mortality (logistic Euroscore >20 or STS score > 12) using Medline databases, international meetings and federal drug administration. We identified 19 studies utilizing MC (n=3164) from 2003 to 2013 and Society of Thoracic Surgical database (STS) query (version 2.61 and 2.73) for MVS (n=3249) from 2008-2012. Information about patient characteristics, surgical risk and 30 day outcomes were extracted.
Results: Patients who underwent MC or MVS had a mean age of 74 ± 10 years with no differences in surgical risk, NYHA class or MR grade (p=0.46). Technical success was achieved in 96 % of patients undergoing using MC versus 98% in MVS group (p= 0.45). Patients undergoing MC were treated with one or two MC in 93% (n=2952) with only a few requiring repeat MC (0.4%, n=58) or mitral surgery (0.3%, n=52) at 30 days. The 30 day event rates for mortality and stroke were 3.2% (95% CI [2.5-4.2]) and 1.1% (95% CI [0.7-0.2]) with the majority of patients in the mild/moderate MR grade and NYHA class at 30 days and 1 year (figure 1 and 2) after MC. The 30 day event rates for mortality and stroke were 16.8% (95% CI [14-19]) and 4.5% (95% CI [3.9-5.3]) after MVS, respectively.
Conclusion: Implantation of MitraClip can be safely accomplished in patients with severe MR at HSR with low 30 day mortality. These findings may serve as the rationale for making this technology available for this high risk group.
- © 2013 by American Heart Association, Inc.