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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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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Impact of percutaneous mitral repair with MitraClip on the natural history of severe mitral regurgitation
Session:
CO8 - Doença Valvular
Speaker:
Joana Margarida Nunes Rigueira
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:
Joana Rigueira; E. Infante de Oliveira; P. Carrilho Ferreira; Inês Aguiar Ricardo; Ana Rita G. Francisco; Miguel Nobre Menezes; Rafael Santos; Afonso Nunes Ferreira; João Pedro Ribeiro Agostinho; Tiago Graça Rodrigues; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Background</strong>: severe mitral regurgitation (MR) under conservative management is associated with high morbidity and mortality. Percutaneous mitral valve repair, with MitraClip System is a complement to medical therapy in patients with surgical contraindication. Recent studies question the impact of this system on mortality.</p> <p><strong>Purpose</strong>: to evaluate the prognostic impact of mitral valve repair with MitraClip in the natural history of severe MR.</p> <p><strong>Methods</strong>: prospective, single-center registry of consecutive patients (pts) undergoing percutaneous MR repair with MitraClip system from 2013 to 2018. Demographic, clinical and echocardiographic data were analyzed. Anticipated 1-year mortality was estimated based on the Seattle Heart Failure Model score (Seattle HF score). Kaplan-Meier curves were analyzed for comparison of predicted mortality (by Seattle HF score) and our sample mortality.</p> <p><strong>Results</strong>: 51 procedures (mean age 71.8 ± 13.5 years, 30 males) were performed in pts with symptomatic MR, grade III or IV. 14 pts (27.5%) had primary MR and 37 (72.5%) had secondary MR.<br /> The mean left ventricular ejection fraction was 39.0 ± 14.1%. The success rate per patient was 92.0% and the complication rate was 7.7% (n=4; 2 procedure failures, 1 pericardial effusion and 1 vascular complication).<br /> During a mean follow-up of 615 ± 613 days, there were 14 hospitalizations due to cardiac cause (27.5%) and 17 deaths (33.3%), 9 of which occurred in the first year(17.6%).</p> <p>According to the Seattle HF score the predicted mean mortality at the end of one year for the sample studied under conservative therapy was 33.1% ± 16.7%, corresponding to 17 deaths. Based on predicted mortality, there was a statistically significant reduction of 8 deaths (LogRank = 4.342, p = 0.037, relative risk reduction of 44.0%).</p> <p><strong>Conclusion</strong>: the percutaneous MR treatment was a safe and effective procedure, with an additional impact on the vital prognosis of pts with severe MR, presenting a relative reduction of mortality risk of more than 40% at 1 year. This reduced real-world experience, with a majority of patients with functional MR, suggests a reduction in mortality that will be in line with the COAPT Trial results.</p>
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