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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Long-term outcomes after Mitraclip implantation
Session:
CO8 - Doença Valvular
Speaker:
João Pedro Dias Ferreira Reis
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Pedro Reis; Luisa Moura Branco; Luís Almeida Morais; Rita Ilhão Moreira; Filipa Ferreira; Fernanda Varela Gameiro; Pedro Rio; Ana Galrinho; António Fiarresga; Duarte Cacela; Rui Cruz Ferreira
Abstract
<p><strong><u>Background:</u></strong> Mitraclip implantation (MI) is a well-established option for patients (P) with severe mitral regurgitation (MR) non-eligible to surgery. Its impact on long term prognosis is being addressed by several recent studies.</p> <p><strong><u>Purpose:</u></strong> To identify predictors of morbidity and mortality in P undergoing MI and evaluate if the COAPT, Everest and MITRA-FR exclusion criteria (EC) had any impact on the outcome of our population.</p> <p><strong><u>Methods:</u></strong> prospective study of P who underwent MI between 2013 and 2018 in one medical center. EC: COAPT: LVEF<20%, LV end-diastolic diameter>70mm or pulmonary artery systolic pressure>70mmHg; Everest: LVEF<25% or LV end-systolic diameter (LVESD)>55mm; MITRA-FR: LVEF<15% or >40% or primary MR. An univariate analysis was performed followed by a multivariate Cox analysis to evaluate overall mortality (M), overall mortality/ heart failure hospitalization (MH) and mortality in the first year post-MI (M1). Survival analysis using Kaplan-Meier plots. p<0.05 were considered significant</p> <p><strong><u>Results: </u></strong>40P, 60% male, mean age 66±12 years (Y) and mean follow-up time of 18±15 months. 67.5% presented with MR grade IV and 75% had functional MR. Successful implantation in 97.5%, with 55% presenting mild MR post-procedure. Overall mortality was 30% (12P), mostly due to cardiovascular causes, with 9P dying in the first year (30%). There was no difference between pts with functional and primary MR: M- 33%vs20% (p=0.6); MH– 53.3%vs30% (p=0.5). P who met the COAPT exclusion criteria (N-22) presented an inferior 1Y survival (64.5%vs86.7%, p=0.046). The overall outcome was comparable between P who matched and didn't match Everest and MITRA-FR exclusion criteria. Basal BNP value (p=0.037), mean pre-procedural MAGGIC score (p=0.040) and EROA (p=0.039) were associated to M1. Multivariate Cox analysis revealed that basal BNP was an independent predictor of M (p=0.017), whereas a higher distance in the pre-procedural 6 minute walk test (p=0.008) and the “reduction in the MR severity and PASP” (p=0.008) presented a protective effect. LVESD>55mm was an independent predictor of MH (p=0.017), but MR of grade 2 or less after procedure was protective (p=0.006).</p> <p><strong><u>Conclusion:</u></strong> There was no M difference between P with functional and primary MR. P with COAPT exclusion criteria had worse 1Y survival. A higher distance in 6MWT and a reduction in MR severity and PASP were protective. An LVESD > 55 mm had a worse prognosis. Careful P selection may be crucial to improve MI's results.</p>
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