Cosmo Godino1, Andrea Munafò2, Andrea Scotti3, Rodrigo Estévez-Loureiro4, Antonio Portolés Hernández4, Dabit Arzamendi5, Estefanía Fernández Peregrina5, Maurizio Taramasso6, Neil P Fam7, Edwin C Ho7, Anita Asgar8, Giancarlo Vitrella9, Claudia Raineri10, Marianna Adamo11, Claudia Fiorina11, Claudio Montalto10, Chiara Fraccaro3, Cristina Giannini12, Francesca Fiorelli12, Antonio Popolo Rubbio13, J F Ooms14, Miriam Compagnone15, Diego Maffeo16, Luca Bettari16, Monika Fürholz17, Corrado Tamburino13, A Sonia Petronio12, Carmelo Grasso13, Eustachio Agricola2, Nicolas M Van Mieghem14, Giuseppe Tarantini3, Salvatore Curello11, Fabien Praz17, Isaac Pascual18, Luciano Potena15, Antonio Colombo2, Francesco Maisano6, Marco Metra11, Alberto Margonato2, Gabriele Crimi19, Francesco Saia15. 1. Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: godino.cosmo@hsr.it. 2. Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. 3. Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy. 4. Department of Cardiology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain. 5. Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 6. Clinic for Heart and Vascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland. 7. Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada. 8. Interventional Cardiology Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. 9. Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste, Trieste, Italy. 10. Division of Cardiology, Fondazione IRCCS Policlinico San Matteo Foundation, Pavia, Italy. 11. Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy. 12. Cardiac Thoracic and Vascular Department, Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy. 13. Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy. 14. Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands. 15. Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. 16. Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy. 17. Department of Cardiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland. 18. Interventional Cardiology Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain. 19. Interventional Cardiology Unit, Cardio Thoraco Vascular Department (DICATOV). IRCCS, AOU San Martino IST, University of Genoa, Genova, Italy.
Abstract
BACKGROUND: Patients awaiting heart transplantation (HTx) often need bridging therapies to reduce worsening and progression of underlying disease. Limited data are available regarding the use of the MitraClip procedure in secondary mitral regurgitation for this clinical condition. METHODS: We evaluated an international, multicenter (17 centers) registry including 119 patients (median age: 58 years) with moderate-to-severe or severe secondary mitral regurgitation and advanced heart failure (HF) (median left ventricular ejection fraction: 26%) treated with MitraClip as a bridge strategy according to 1 of the following criteria: (1) patients active on HTx list (in list group) (n = 31); (2) patients suitable for HTx but awaiting clinical decision (bridge to decision group) (n = 54); or (3) patients not yet suitable for HTx because of potentially reversible relative contraindications (bridge to candidacy group) (n = 34). RESULTS: Procedural success was achieved in 87.5% of cases, and 30-day survival was 100%. At 1 year, Kaplan-Meier estimates of freedom from the composite primary end-point (death, urgent HTx or left ventricular assist device implantation, first rehospitalization for HF) was 64%. At the time of last available follow-up (median: 532 days), 15% of patients underwent elective transplant, 15.5% remained or could be included in the HTx waiting list, and 23.5% had no more indication to HTx because of clinical improvement. CONCLUSIONS: MitraClip procedure as a bridge strategy to HTx in patients with advanced HF with significant mitral regurgitation was safe, and two thirds of patients remained free from adverse events at 1 year. These findings should be considered exploratory and hypothesis-generating to guide further study for percutaneous intervention in high-risk patients with advanced HF.
BACKGROUND:Patients awaiting heart transplantation (HTx) often need bridging therapies to reduce worsening and progression of underlying disease. Limited data are available regarding the use of the MitraClip procedure in secondary mitral regurgitation for this clinical condition. METHODS: We evaluated an international, multicenter (17 centers) registry including 119 patients (median age: 58 years) with moderate-to-severe or severe secondary mitral regurgitation and advanced heart failure (HF) (median left ventricular ejection fraction: 26%) treated with MitraClip as a bridge strategy according to 1 of the following criteria: (1) patients active on HTx list (in list group) (n = 31); (2) patients suitable for HTx but awaiting clinical decision (bridge to decision group) (n = 54); or (3) patients not yet suitable for HTx because of potentially reversible relative contraindications (bridge to candidacy group) (n = 34). RESULTS: Procedural success was achieved in 87.5% of cases, and 30-day survival was 100%. At 1 year, Kaplan-Meier estimates of freedom from the composite primary end-point (death, urgent HTx or left ventricular assist device implantation, first rehospitalization for HF) was 64%. At the time of last available follow-up (median: 532 days), 15% of patients underwent elective transplant, 15.5% remained or could be included in the HTx waiting list, and 23.5% had no more indication to HTx because of clinical improvement. CONCLUSIONS: MitraClip procedure as a bridge strategy to HTx in patients with advanced HF with significant mitral regurgitation was safe, and two thirds of patients remained free from adverse events at 1 year. These findings should be considered exploratory and hypothesis-generating to guide further study for percutaneous intervention in high-risk patients with advanced HF.
Authors: Henrik Fox; Takayuki Gyoten; Sebastian V Rojas; Marcus-André Deutsch; René Schramm; Volker Rudolph; Jan F Gummert; Michiel Morshuis Journal: J Cardiovasc Transl Res Date: 2021-10-28 Impact factor: 3.216
Authors: Daniele Masarone; Andrea Petraio; Antonio Fiorentino; Santo Dellegrottaglie; Fabio Valente; Ernesto Ammendola; Gerardo Nigro; Giuseppe Pacileo Journal: Front Cardiovasc Med Date: 2022-02-16
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