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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
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
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15. Valvular Heart Disease
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Percutaneous mitral valve repair with the MitraClip system - Meta-Analysis vs. Medical Therapy
Session:
Posters 2 - Écran 2 - Doença Valvular
Speaker:
José Pedro Sousa
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:
Posters
FP Number:
---
Authors:
José Pedro Sousa; Rogerio Teixeira; Joana M. Ribeiro; Luís Puga; João Gameiro; Carolina Négrier; Lino Gonçalves
Abstract
<p><strong>Introduction: </strong>Functional mitral regurgitation is a common finding in heart failure, increasing morbidity and mortality. Its management, either with pharmacotherapy or surgical correction, is controversial, with no consistent survival benefit. Percutaneous mitral valve repair (PMVR) with the MitraClip system provides an attractive option, but its impact on outcomes is not well established.</p> <p><strong>Aim: </strong>To compare hard outcomes of a combination strategy of PMVR with MitraClip and medical therapy with those of medical therapy alone in patients with functional mitral regurgitation complicating myocardial dysfunction.</p> <p><strong>Methods: </strong>MEDLINE, Pubmed Central and Google Scholar databases were comprehensively searched for published studies enrolling patients with predominantly functional (≥80%) moderate-to-severe mitral regurgitation, while evaluating PMVR with MitraClip plus medical therapy vs. medical therapy alone. A random-effects meta-analysis was performed. The primary efficacy endpoint was total mortality on follow-up, whereas cardiovascular mortality and hospital admission (compound measure of all-cause, cardiovascular and heart failure-specific hospitalizations) were regarded as secondary efficacy outcomes. 30-day mortality was the primary safety endpoint. Major bleeding demanding red blood cell transfusion, as a marker of vascular complications of the PMVR procedure, was also considered.</p> <p><strong>Results: </strong>Seven eligible studies were identified. Of these, two were randomized controlled trials and the others were observational. Overall, 3.015 patients were included, of whom 1.286 were treated with MitraClip plus medical therapy and 1.729 with medical therapy alone. The prototype patient was an elderly men with highly symptomatic (NYHA Class III-IV) heart failure, left ventricular systolic dysfunction of ischemic etiology, high estimated surgical risk and a pronounced burden of comorbidities, namely atrial fibrillation (nearly one half), chronic kidney disease and chronic obstructive pulmonary disease (about one fourth). Around one third had received resynchronization therapy. Clinical follow-up was documented at a median of 626 days. The addition of PMVR with MitraClip to medical therapy markedly reduced all-cause mortality (pooled OR=0.51, p=0.004, i²=81%). An analogous impact was seen on cardiovascular mortality (pooled OR=0.38, p=0.02, i²=89%) and hospitalization rates (pooled OR=0.31, p=0.01, i²=94%). 30-day mortality was similar between groups (pooled OR=0.91, p=0.07) and major bleeding complicating the PMVR procedure was rare (5.6%).</p> <p><strong>Conclusion: </strong>In a high-risk sample of patients with functional moderate-to-severe mitral regurgitation, the addition of PMVR with MitraClip to medical therapy was associated with a significantly lower risk of all-cause and cardiovascular-specific death and hospital admission, while proving itself to be a safe procedure.</p>
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