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Outcomes following urgent percutaneous mitral valve repair: a single center observational study

Session Moderated Poster 1: Interventional cardiology

Speaker Carlos Minguito Carazo

Congress : Acute Cardiovascular Care 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Interventional Cardiology - Other
  • Session type : Moderated Posters
  • FP Number : 32

Authors : D Samuel Del Castillo Garcia (Leon,ES), D Carlos Minguito Carazo (Leon,ES), D Tomas Benito Gonzalez (Leon,ES), D Rodrigo Estevez Loureiro (Leon,ES), DRA Carmen Garrote Coloma (Leon,ES), DR David Alonso Rodriguez (Leon,ES), D Miguel Rodriguez Santamarta (Leon,ES), DRA Guisela Flores Vergara (Leon,ES), D Javier Borrego Rodriguez (Leon,ES), D Julio Cesar Echarte Morales (Leon,ES), D Paula Menendez Suarez (Leon,ES), D Carlos Cuellas Ramon (Leon,ES), DR Armando Perez De Prado (Leon,ES), DR Javier Gualis Cardona (Leon,ES), DR Felipe Fernandez Vazquez (Leon,ES)

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Authors:
D Samuel Del Castillo Garcia1 , D Carlos Minguito Carazo1 , D Tomas Benito Gonzalez1 , D Rodrigo Estevez Loureiro1 , DRA Carmen Garrote Coloma1 , DR David Alonso Rodriguez1 , D Miguel Rodriguez Santamarta1 , DRA Guisela Flores Vergara1 , D Javier Borrego Rodriguez1 , D Julio Cesar Echarte Morales1 , D Paula Menendez Suarez1 , D Carlos Cuellas Ramon1 , DR Armando Perez De Prado1 , DR Javier Gualis Cardona1 , DR Felipe Fernandez Vazquez1 , 1Hospital of Leon, Cardiology - Leon - Spain ,

Citation:

Background
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

Purpose
Our aim was to examine procedural and clinical outcomes among patients undergoing PMVR within and admission for ADHF

Methods
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.

Results
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

Conclusions:
PMVR with Mitraclip is safe and effective alternative in patients with high surgical risk within an admission for ADHF

Elective PMVR (n=71) Urgent PMVR (N=15) P value
Age 77.0 [70-83.4] 68.7 [61.3-80.5] 0.127

Masculine Sex (%)

Diabetes

Glomerular filtrate rate ≤30ml/min/m2 (%)

65.7

27.1

8.6

60

46.7

20

0.674

0.215

0.192

Etiology MR

-Functional ischemic MR (%)

-Functional non-ischemic MR (%)

-Degenerative

35.7

37.1

27.1

66.7

20

13.3

0.096

Ischemic heart disease (%)

Myocardial infarction

Coronary Revascularization

Perutaneous coronary intervention

48.6

31.4

40

34.3

66.7

60

60

60

0.203

0.156

0.064

Left Ventricular Ejection fraction (%) 34.6 [28.6-53.9] 43.5 [30.1-56.5] 0.451
Logistic Euroscore (%)

4.6 [2.7-8.1]

13.6 [5.0-21.6] 0.003

Procedure outcomes:

Sucessful Clip Implantation (%)

Number of clips

Procedural mortality (%)

100

1 [1-2]

0

100

1 [1-2]

0

1

0.810

0

30-Day outcomes:

Stroke/TIA(%)

Major Vascular Complications (%)

Life-threatening bleeding (%)

Acute Kidney injury Stage 2 or 3 (%)

Death (%)

Procedural Sucess (%)

0/2.9

4.3

0

0

1.4

82.9

0/0

0

0

13.3

0

86.7

1

1

1

0.029

1

1

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