Patients with acute decompensated heart failure (ADHF) and severe mitral regurgitation (MR) are at high risk for surgery. Data regarding urgent percutaneous mitral valve repair (PMVR) are limited to a few case reports
Our aim was to examine procedural and clinical outcomes among patients undergoing PMVR within and admission for ADHF
Prospective registry of all consecutive patients with symptomatic MR grade 3+/4+ who underwent PMVR in our centre between June/14-March/18 was performed. A patient was considered for urgent PMVR in case of clinical or hemodynamic instability, such as acute or subacute MR, recurrent episodes of pulmonary edema or cardiogenic shock. Clinical follow up was carried out including primary hospitalizations for HF, cardiovascular mortality and all-cause mortality.
Eighty-five patients were treated with PMVR in our center. Among them, fifteen patients underwent MitraClip implantation within an admission for ADHF. Characteristics of studied population are summarized in Table 1. The subgroup of patients who underwent urgent PMVR had higher prevalence of prior myocardial infarction (p=0.037) and percutaneous coronary intervention (0.067); lower left ventricular (p=0.020) , worse clinical status (p=0.000); higher levels of NT-proBNP (p=0.070) and high sensitive Troponin (p=0.012); and were at a higher risk for conventional mitral valve surgery (p < 0.01). Prevalence of comorbidities was similar to other contemporary cohorts of PMVR. During a median follow up of 661 [437-976] days, 19 (22.4%) patients died, 14 (16.5%) due to a cardiovascular cause, and 26 (30.6%) patients were hospitalized for HF. No differences in the incidence of adverse events were found between elective and urgent procedures (Table 1). Figure 1 shows Kaplan Meier survival free of events
PMVR with Mitraclip is safe and effective alternative in patients with high surgical risk within an admission for ADHF