Antonio Popolo Rubbio1, Luca Testa2, Carmelo Grasso3, Antonio Sisinni2, Maurizio Tusa2, Eustachio Agricola4, Federico De Marco2, Anna Sonia Petronio5, Matteo Montorfano4, Rodolfo Citro6, Marianna Adamo7, Antonio Mangieri8, Matteo Casenghi2, Anna Lisa Milici3, Laura Stazzoni5, Antonio Colombo8, Corrado Tamburino3, Francesco Bedogni2. 1. Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. Electronic address: antonio.rubbio@gmail.com. 2. Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 3. Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy. 4. Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy. 5. Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. 6. University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. 7. Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy. 8. Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital IRCCS, Milan, Italy.
Abstract
BACKGROUND: A-FMR is considered a specific sub-type of secondary MR in patients with atrial fibrillation (AF) and preserved left ventricle ejection fraction (LVEF). Aim of the study was to investigate the acute and mid-term outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) with the MitraClip in atrial functional mitral regurgitation (A-FMR). METHODS: The study included patients with A-FMR and concomitant AF who underwent to the MitraClip at 7 Italian Centers. Aim of the study was to assess the safety, efficacy and mid-term cardiovascular outcomes. RESULTS: After reviewing 1153 patients with FMR treated with TMVr from 2009 to 2021, 87 patients (median age 81 years, 61% female) with A-FMR were identified. Technical success was achieved in 97%, 30-day device success in 83% and 30-day procedural success in 80%. All-cause death at 30-day was 5%. Estimated two-year freedom from all-cause death and cardiac death was 60% and 77%, respectively, whereas freedom from all-cause death/heart failure hospitalization was 55%. Residual MR ≤ 2+ was encountered in 89% (n = 47/53) and improvement in NYHA class I/II in 79% (n = 48/61). Post-procedural MR ≥ 2+ (HR 5.400, CI 1.371-21.268) and inter-commissural annular diameter ≥ 35 mm (HR 4.159, CI 1.057-16.363) were independent predictors of all-cause death/heart failure hospitalization during the follow-up. Positive reverse remodeling of left atrium and mitral annular dimensions occurred after TMVr during the follow-up. CONCLUSIONS: MitraClip resulted to be a safe and effective option to treat A-FMR in elderly patients.
BACKGROUND: A-FMR is considered a specific sub-type of secondary MR in patients with atrial fibrillation (AF) and preserved left ventricle ejection fraction (LVEF). Aim of the study was to investigate the acute and mid-term outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) with the MitraClip in atrial functional mitral regurgitation (A-FMR). METHODS: The study included patients with A-FMR and concomitant AF who underwent to the MitraClip at 7 Italian Centers. Aim of the study was to assess the safety, efficacy and mid-term cardiovascular outcomes. RESULTS: After reviewing 1153 patients with FMR treated with TMVr from 2009 to 2021, 87 patients (median age 81 years, 61% female) with A-FMR were identified. Technical success was achieved in 97%, 30-day device success in 83% and 30-day procedural success in 80%. All-cause death at 30-day was 5%. Estimated two-year freedom from all-cause death and cardiac death was 60% and 77%, respectively, whereas freedom from all-cause death/heart failure hospitalization was 55%. Residual MR ≤ 2+ was encountered in 89% (n = 47/53) and improvement in NYHA class I/II in 79% (n = 48/61). Post-procedural MR ≥ 2+ (HR 5.400, CI 1.371-21.268) and inter-commissural annular diameter ≥ 35 mm (HR 4.159, CI 1.057-16.363) were independent predictors of all-cause death/heart failure hospitalization during the follow-up. Positive reverse remodeling of left atrium and mitral annular dimensions occurred after TMVr during the follow-up. CONCLUSIONS: MitraClip resulted to be a safe and effective option to treat A-FMR in elderly patients.
Authors: Zhang Xiling; Thomas Puehler; Lars Sondergaard; Derk Frank; Hatim Seoudy; Baland Mohammad; Oliver J Müller; Stephanie Sellers; David Meier; Janarthanan Sathananthan; Georg Lutter Journal: J Clin Med Date: 2022-06-13 Impact factor: 4.964