MitraClip in secondary mitral regurgitation as a bridge to heart transplantation: 1-year outcomes from the International MitraBridge Registry

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:39

Article

Godino, Cosmo¹  Munafo, Andrea¹  Scotti, Andrea²  Estevez-Loureiro, Rodrigo³  Portoles Hernandez, Antonio³  Arzamendi, Dabit⁴  Fernandez Peregrina, Estefania⁴  Taramasso, Maurizio⁵  Fam, Neil P.⁶  Ho, Edwin C.⁶  Asgar, Anita⁷  Vitrella, Giancarlo⁸  Raineri, Claudia⁹  Adamo, Marianna¹⁰  Fiorina, Claudia¹⁰  Montalto, Claudio⁹  Fraccaro, Chiara²  Giannini, Cristina¹¹  Fiorelli, Francesca¹¹  Rubbio, Antonio Popolo¹²  Ooms, J. F.¹³  Compagnone, Miriam¹⁴  Maffeo, Diego¹⁵  Bettari, Luca¹⁵  Furholz, Monika¹⁶  Tamburino, Corrado¹²  Petronio, A. Sonia¹¹  Grasso, Carmelo¹²  Agricola, Eustachio¹  Van Mieghem, Nicolas M.¹³  Tarantini, Giuseppe²  Curello, Salvatore¹⁰  Praz, Fabien¹⁶  Pascual, Isaac¹⁷  Potena, Luciano¹⁴  Colombo, Antonio¹  Maisano, Francesco⁵  Metra, Marco¹⁰  Margonato, Alberto¹  Crimi, Gabriele¹⁸  Saia, Francesco¹⁴ 

[1] Ist Sci San Raffaele, Cardio Thorac Vasc Dept, Milan, Italy

[2] Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Med Sch, Padua, Italy

[3] Univ Hosp Puerta Hierro Majadahonda, Dept Cardiol, Madrid, Spain

[4] Univ Autonoma Barcelona, Intment Cardiol Unit, Hosp Santa Creu & St Pau, Cardiol Dept, Barcelona, Spain

[5] Univ Zurich, Univ Hosp Zurich, Clin Heart & Vasc Surg, Zurich, Switzerland

[6] St Michaels Hosp, Div Cardiol, Toronto, ON, Canada

[7] Univ Montreal, Intervent Cardiol Unit, Montreal Heart Inst, Montreal, PQ, Canada

[8] Azienda Sanitaria Univ Integrata Trieste, Cardiovasc Dept, Trieste, Italy

[9] Fdn IRCCS Policlin San Matteo Fdn, Div Cardiol, Pavia, Italy

[10] Spedali Civili Brescia, Catheterizat Lab, Cardiothorac Dept, Brescia, Italy

[11] Univ Pisa, Dept Anesthesia & Intens Care, Cardiac Thorac & Vasc Dept, Pisa, Italy

[12] Azienda Ospedaliero Univ Policlin Vittorio Emanue, Div Cardiol, Cardio Thorac Vasc Dept, Catania, Italy

[13] Erasmus MC, Dept Cardiol Thoraxctr, Rotterdam, Netherlands

[14] Univ Hosp Bologna, Cardio Thoraco Vasc Dept, Cardiol Unit, Policlin S Orsola Malpighi, Bologna, Italy

[15] Fdn Poliambulanza Ist Ospedaliero, Cardiovasc Dept, Brescia, Italy

[16] Univ Bern, Bern Univ Hosp Inselspital, Dept Cardiol, Bern, Switzerland

[17] Hosp Univ Cent Asturias HUCA, Intervent Cardiol Unit, Oviedo, Spain

[18] Univ Genoa, Intervent Cardiol Unit, Cardio Thoraco Vasc Dept DICATOV, AOU San Martino IST,IRCCS, Genoa, Italy

关键词: MitraClip;    secondary mitral regurgitation;    advanced heart failure;    heart transplantation;    transcatheter mitral valve intervention;   

DOI  :  10.1016/j.healun.2020.09.005

来源: Elsevier

【 摘 要 】

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. (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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