Percutaneous edge-to-edge repair in high-risk and elderly patients with degenerative mitral regurgitation: midterm outcomes in a single-center experience

Maurizio Taramasso, Francesco Maisano, Paolo Denti, Azeem Latib, Giovanni La Canna, Antonio Colombo, Ottavio Alfieri
Journal of Thoracic and Cardiovascular Surgery 2014, 148 (6): 2743-50

OBJECTIVE: The study objective was to report the midterm outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with degenerative mitral regurgitation.

METHODS: From October 2008, data of all high-risk or elderly patients with severe degenerative mitral regurgitation who underwent MitraClip implantation were prospectively collected.

RESULTS: Forty-eight high-risk consecutive patients with severe degenerative mitral regurgitation underwent MitraClip implantation (mean age, 78.5 ± 10.8 years; 56.6% of the patients were aged ≥ 80 years). Mean Society of Thoracic Surgeons score was 12% ± 10%, and 71% were in New York Heart Association class III or IV. Mean left ventricular ejection fraction was 57% ± 11%. The device was successfully implanted in 47 of 48 patients (98%). In-hospital mortality was 2%. The median intensive care unit stay was 22 hours; patients were discharged from the hospital in an average of 4.5 ± 2.4 days. Predischarge echocardiography showed a mitral regurgitation reduction to grade 2+ or less in 43 of 47 patients (91.5%). Actuarial survival was 89% ± 5.2% and 70.2% ± 9% at 1 and 2 years, respectively (82% ± 9% in patients aged <80 years and 95% ± 4.4% in patients aged ≥ 80 years at 1 year; P = .9). Freedom from mitral regurgitation 3+ or greater was 80% ± 7% at 1 year and 76.6% ± 7% at 2 years. At 1 year, 93% of survivors were in New York Heart Association class I or II (100% of patients aged <80 years and 88% of patients aged ≥ 80 years; P = .4). Significant quality of life improvements were documented. A significant improvement in 6-minute walk test performance was observed.

CONCLUSIONS: MitraClip therapy is a valuable alternative to surgery in high-risk and elderly patients with degenerative mitral regurgitation. Clinical benefits also are obtained in octogenarians.

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