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Surgical or percutaneous mitral valve repair for secondary mitral regurgitation: comparison of patient characteristics and clinical outcomes.
Eur J Cardiothorac Surg. 2013 Sep; 44(3):490-6; discussion 496.EJ

Abstract

OBJECTIVES

Corrective surgery for secondary mitral regurgitation (MR) by restrictive annuloplasty has proven beneficial in that it improves New York Heart Association (NYHA) functional class and induces reverse left ventricular remodelling. However, proof of a survival benefit for these patients is still pending. Percutaneous techniques of mitral valve repair (MVR) have become a viable treatment alternative for selected high-risk patients with severe secondary MR.

METHODS

We retrospectively analysed our prospective hospital database of patients with severe secondary MR undergoing either surgical MVR or percutaneous treatment using the MitraClip device. Patient characteristics and 6-month clinical and effectiveness outcomes are reported.

RESULTS

From March 2002 through June 2010, 76 patients with secondary MR underwent isolated surgical MVR, while 95 were treated using the MitraClip device at our centre. Patients undergoing MitraClip treatment were significantly older (mean 72.8 ± 8.2 vs 64.5 ± 11.4 years, P < 0.001), had a lower left ventricular ejection fraction (mean 36.2 ± 12.5 vs 42.1 ± 16.2%, P = 0.014) and were generally more high risk, with a significantly higher mean logistic EuroSCORE I compared with surgical candidates (33.7 ± 18.7 vs 10.1 ± 8.7%, P < 0.001). Procedural success was 98.7 (75 of 76) for MVR and 95.8% (91 of 95) for MitraClip treatment (P = 0.383). Thirty-day mortality was 4.2 (4 of 95) and 2.6% (2 of 76; P = 0.557), and the mean grade of residual MR was 1.4 ± 0.8 and 0.2 ± 0.4 (P < 0.001) after MitraClip treatment and surgical MVR, respectively. Six-month survival rates after adjustment for baseline differences were not significantly different in the respective groups (P = 0.642).

CONCLUSIONS

In our experience, characteristics and risk factors of patients with severe secondary MR undergoing surgery differ significantly from those considered for percutaneous therapy. Surgery was more effective compared with MitraClip in reducing MR. However, a large proportion of patients benefits from percutaneous intervention with sustained MR Grade <2+ and improvement in NYHA functional class at 6 months. MitraClip therapy seems to be an adequate alternative to surgery, especially for elderly patients with reduced left ventricular function and relevant comorbidities. Assessment, treatment and postprocedural care of patients by an interdisciplinary team are of paramount importance for clinical success.

Authors+Show Affiliations

University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. lconradi@uke.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23401496

Citation

Conradi, Lenard, et al. "Surgical or Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: Comparison of Patient Characteristics and Clinical Outcomes." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 44, no. 3, 2013, pp. 490-6; discussion 496.
Conradi L, Treede H, Rudolph V, et al. Surgical or percutaneous mitral valve repair for secondary mitral regurgitation: comparison of patient characteristics and clinical outcomes. Eur J Cardiothorac Surg. 2013;44(3):490-6; discussion 496.
Conradi, L., Treede, H., Rudolph, V., Graumüller, P., Lubos, E., Baldus, S., Blankenberg, S., & Reichenspurner, H. (2013). Surgical or percutaneous mitral valve repair for secondary mitral regurgitation: comparison of patient characteristics and clinical outcomes. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 44(3), 490-6; discussion 496. https://doi.org/10.1093/ejcts/ezt036
Conradi L, et al. Surgical or Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: Comparison of Patient Characteristics and Clinical Outcomes. Eur J Cardiothorac Surg. 2013;44(3):490-6; discussion 496. PubMed PMID: 23401496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical or percutaneous mitral valve repair for secondary mitral regurgitation: comparison of patient characteristics and clinical outcomes. AU - Conradi,Lenard, AU - Treede,Hendrik, AU - Rudolph,Volker, AU - Graumüller,Paul, AU - Lubos,Edith, AU - Baldus,Stephan, AU - Blankenberg,Stefan, AU - Reichenspurner,Hermann, Y1 - 2013/02/10/ PY - 2013/2/13/entrez PY - 2013/2/13/pubmed PY - 2014/5/10/medline KW - Functional mitral regurgitation KW - MitraClip KW - Mitral valve repair KW - Percutaneous SP - 490-6; discussion 496 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 44 IS - 3 N2 - OBJECTIVES: Corrective surgery for secondary mitral regurgitation (MR) by restrictive annuloplasty has proven beneficial in that it improves New York Heart Association (NYHA) functional class and induces reverse left ventricular remodelling. However, proof of a survival benefit for these patients is still pending. Percutaneous techniques of mitral valve repair (MVR) have become a viable treatment alternative for selected high-risk patients with severe secondary MR. METHODS: We retrospectively analysed our prospective hospital database of patients with severe secondary MR undergoing either surgical MVR or percutaneous treatment using the MitraClip device. Patient characteristics and 6-month clinical and effectiveness outcomes are reported. RESULTS: From March 2002 through June 2010, 76 patients with secondary MR underwent isolated surgical MVR, while 95 were treated using the MitraClip device at our centre. Patients undergoing MitraClip treatment were significantly older (mean 72.8 ± 8.2 vs 64.5 ± 11.4 years, P < 0.001), had a lower left ventricular ejection fraction (mean 36.2 ± 12.5 vs 42.1 ± 16.2%, P = 0.014) and were generally more high risk, with a significantly higher mean logistic EuroSCORE I compared with surgical candidates (33.7 ± 18.7 vs 10.1 ± 8.7%, P < 0.001). Procedural success was 98.7 (75 of 76) for MVR and 95.8% (91 of 95) for MitraClip treatment (P = 0.383). Thirty-day mortality was 4.2 (4 of 95) and 2.6% (2 of 76; P = 0.557), and the mean grade of residual MR was 1.4 ± 0.8 and 0.2 ± 0.4 (P < 0.001) after MitraClip treatment and surgical MVR, respectively. Six-month survival rates after adjustment for baseline differences were not significantly different in the respective groups (P = 0.642). CONCLUSIONS: In our experience, characteristics and risk factors of patients with severe secondary MR undergoing surgery differ significantly from those considered for percutaneous therapy. Surgery was more effective compared with MitraClip in reducing MR. However, a large proportion of patients benefits from percutaneous intervention with sustained MR Grade <2+ and improvement in NYHA functional class at 6 months. MitraClip therapy seems to be an adequate alternative to surgery, especially for elderly patients with reduced left ventricular function and relevant comorbidities. Assessment, treatment and postprocedural care of patients by an interdisciplinary team are of paramount importance for clinical success. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/23401496/Surgical_or_percutaneous_mitral_valve_repair_for_secondary_mitral_regurgitation:_comparison_of_patient_characteristics_and_clinical_outcomes_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezt036 DB - PRIME DP - Unbound Medicine ER -