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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Severe mitral regurgitation: mortality and morbidity predictors after percutaneous mitral valve repair with the MitraClip system
Session:
Posters 1 - Écran 6 - Cardiologia de Intervenção
Speaker:
Rafael Santos
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
Rafael Santos; E. Infante de Oliveira; P. Carrilho Ferreira; Miguel Nobre Menezes; Ana Rita G. Francisco; Joana Rigueira; Inês Aguiar Ricardo; Pedro Morais; Nelson P. Cunha; Tiago Graça Rodrigues; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction:</strong></p> <p>Percutaneous mitral valve repair with the MitraClip system is an alternative in cases of severe mitral regurgitation (MR) with prohibitive surgical risk. Therefore, it’s relevant to analyse factors that impact prognosis after percutaneous valve repair, and select patients that can most benefit from the procedure.</p> <p><strong>Aims:</strong></p> <p>To identify predictors of bad prognosis after MitraClip implantation.</p> <p><strong>Methods:</strong></p> <p>Single centre, prospective registry of consecutive patients (pts) submited to percutaneous mitral valve repair with the MitraClip system from 2013 to 2018. Clinical, echocardiographic and demographic parameters were analysed. Follow up was presential or by phone call. For statistical analysis a primary compound <em>endpoint</em> of global mortality and/or admission from cardiac cause was used. Qui-square(χ2) test, T-student test, ROC analysis and Kaplan-Meier survival analysis were applied.</p> <p><strong>Results:</strong></p> <p>The analysis included 51 procedures (average age was 71,8±13,5 years; 30 were male pts) performed in grade III or IV symptomatic MR pts. 14 pts (27,5%) had primary MR and 37 (72,5%) had secondary MR. Left ventricular ejection fraction (LVEF) averaged 39,0±14,1%. Success rate per patient was 92,0%. Complication rate was 7,7% (n=4; 2 procedure failures, 1 pericardial effusion and 1 vascular complication). 14 admissions from cardiac cause (27,5%) and 17 deaths (33,3%) were verified during an average follow up of 615±13 days. The compound <em>endpoint</em> of global mortality and/or admission from cardiac cause was verified in 43,1% of pts.</p> <p>During the abovementioned follow up, functional class (NYHA) was higher in pts that reached primary <em>endpoint</em> (2,4 ± 0,9 vs 1,7± 0,5; p = 0,045), the same was true for MR grade (grade III/IV 17,7% vs 8,8%, p=0,041) and LVEF was lower in those pts (35,2 ± 12,3% vs 40,9 ± 17,2%; p=0,033). Using ROC analysis a LVEF<30% was identified as the cut-off assotiated with mortality or admission from cardiac cause (AUC = 0,67; Sensitivity= 55,0%; Specificity= 90,0%, PPV 80%, NPV 72%). Pre-procedural NHYA class (OR 7,065 p=0,014), atrial fibrillation (OR 0,039 p=0,039) and immediate complications (OR 720,6 p=0,024) were identified as predictors of the compound <em>endpoint</em>. In the Kaplan-Meier survival analysis a pre-procedural LVEF <30% was associated with the primary <em>endpoint</em>. There were no other identified mortality and/or admission predictors.</p> <p><strong>Conclusion:</strong></p> <p>Percutaneous mitral valve repair in cases of severe mitral regurgitation showed an elevated success rate with a reduced complication rate. The primary compound <em>endpoint</em> of mortality and/or admission from cardiac cause occurred in patients with higher NHYA functional class, higher mitral regurgitation grade, immediate complications, atriall fibrillation and LVEF <30%.</p> <p> </p>
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