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Transcatheter mitral valve repair in NYHA IV patients

Session Poster Session 1

Speaker Alberto Alperi

Congress : Acute Cardiovascular Care 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Interventional Cardiology - Other
  • Session type : Poster Session
  • FP Number : P283

Authors : A Alperi (Oviedo,ES), I Pascual (Oviedo,ES), V Leon (Oviedo,ES), R Padron Encalada (Oviedo,ES), I Silva Conde (Oviedo,ES), A Martinez Leon (Oviedo,ES), P Florez Llano (Oviedo,ES), L Gutierrez De La Varga (Oviedo,ES), L Diaz Chiron (Oviedo,ES), R Diaz (Oviedo,ES), D Hernandez-Vaquero (Oviedo,ES), JM De La Hera (Oviedo,ES), P Avanzas (Oviedo,ES), C Moris De La Tassa (Oviedo,ES)

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Authors:
A Alperi1 , I Pascual1 , V Leon1 , R Padron Encalada1 , I Silva Conde1 , A Martinez Leon1 , P Florez Llano1 , L Gutierrez De La Varga1 , L Diaz Chiron1 , R Diaz1 , D Hernandez-Vaquero1 , JM De La Hera1 , P Avanzas1 , C Moris De La Tassa1 , 1University Hospital Central de Asturias - Oviedo - Spain ,

Citation:

Purpose
Transcatheter mitral valve repair (TMVR) using the edge-to-edge technique with the Mitraclip® system is increasingly used to treat patients with mitral regurgitation (MR) and high surgical risk. We sought to assess outcomes of TMVR in patients with severe heart failure in New York Heart Association (NYHA) class IV.
Methods
Inclusion of patients accepted for TMVR between October 2015 and September 2018. Clinical and echocardiographic characteristics were assessed before and after procedure. Survival and survival-free from heart failure was evaluated with Kaplan-Meier´s method.
Results
44 patients: 34 in NYHA class II-III, 10 in NYHA class IV (5 ambulatory IV, 5 hospitalised IV). There were no complications during procedure.
Basal characteristics of patients in each group are shown in table 1. Mean follow-up time of 267 days (interquartile range 102 – 655 days). Grade of MR before, immediately after procedure and at 6 month-follow-up are shown in figure 1, with no significant differences between groups. 
At one year of follow-up all patients in the NYHA IV group were alive vs 84% of patients in the NYHA I-III group. Survival free from heart failure admission was 79.43% at one year in the NYHA IV group and 74.53% in the NYHA I-III group.
Conclusions
TMVR performed in advanced and acute descompensated heart failure patients is safe. Survival results and decrease in MR grade are maintained in this subgroup.

NYHA IV patients (10) NYHA I-III patients (34)
Age 72.9±5 75.8±7
Male 90% 64.7%
Hypertension 73.5% 64%
Diabetes Mellitus 40% 23.4%
Dyslipidaemia 50% 41.2%
Ischaemic cardiomyopathy 80% 47%
Ejection fraction 40.01% 41.9%
Atrial fibrillation 50% 58.4%
Pulmonary hypertension (at least moderate) 90% 56%
Atrial fibrillation 50% 58%
GFRe < 60 mL/min 80% 35.2%
Stroke 30% 20.6%
STS score 5.16 4.57
Basal characteristics between groups


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