Percutaneous mitral valve repair with the MitraClip system in the elderly: One-year outcomes from the GRASP registry

Salvatore Scandura, Piera Capranzano, Anna Caggegi, Carmelo Grasso, Giuseppe Ronsivalle, Sarah Mangiafico, Yohei Ohno, Guilherme F Attizzani, Stefano Cannata, Sandra Giaquinta, Silvia Farruggio, Margherita Ministeri, Fabio Dipasqua, Anna M Pistritto, Sebastiano Immè, Davide Capodanno, Maria Elena Di Salvo, Corrado Tamburino
International Journal of Cardiology 2016 December 1, 224: 440-446

BACKGROUND: Although mitral regurgitation (MR) affects a relevant and increasing number of elderly, an optimal management of this high-risk population is challenging.

METHODS AND RESULTS: The aim of this prospective, observational study was to compare one-year outcomes of MitraClip therapy in high surgical risk patients with moderate-to-severe or severe MR between patients aged <75 versus ≥75years. A total of 180 patients were included: 92 were <75years and 88 were ≥75years old. At one-year follow-up the primary efficacy endpoint (composite of death, surgery for mitral valve dysfunction and grade 3+ or 4+ MR) occurred in 41 patients (24.5%), with similar rates between those aged <75years (23.9%) and those ≥75years (25.2%), p=0.912. A total of 21 (12.2%) deaths were observed within 1year after the MitraClip procedure, without significant differences in cumulative mortality rates between elderly and younger patients (10.8% vs. 13.3%, respectively, p=0.574). Compared with baseline, the significant reduction in MR severity achieved after the procedure was sustained at one-year follow-up, in both elderly and younger patients and a significant improvement in NYHA functional class was observed in both groups. A total of 18 (10.0%) patients experienced a re-hospitalization for acute heart failure within one-year after the MitraClip procedure, with no significant differences between elderly and younger. At one-year follow-up both elderly and younger patients showed significant reductions in left ventricular volumes, with changes of similar extent between the two subgroups.

CONCLUSIONS: MitraClip therapy can be considered a viable option also among subsets with more advanced age.

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