SPC365

Refining patient selection to percutaneous mitral valve repair in secondary mitral regurgitation

Session: Comunicações Orais (Sessão 21) - Intervenção Cardíaca Coronária e Estrutural 3 - Vários Tópicos
Speaker: Ana Lobato de Faria Abrantes

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Abrantes; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Margarida Martins; Catarina Simões de Oliveira; Ana Beatriz Garcia; Catarina Gregório; Miguel Nobre Menezes; Cláudia Jorge; João Silva Marques; Fausto j. Pinto; Pedro Cardoso

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Secondary mitral regurgitation (SMR) may lead to functional limitation and carries a poor prognosis in heart failure (HF) patients (pts). These patients often have high or prohibitive surgical risk and the remodeling achieved with optimal medical therapy frequently fails to significantly reduce MR. Percutaneous mitral valve repair (PMVR) emerged as a valuable therapeutic modality despite conflicting evidence from clinical trials.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Our aim:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> is to find predictors of MR improvement after PMVR that may help refine patient selection.&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Twenty-five consecutive pts with grade 3 and 4 SMR submitted to PMVR with MitraClip between 2013 and 2021 were included in this single center study. Demographic, clinical and echocardiographic data (TTE, including left ventricle (LV) and right ventricle (RV) strain) before PMVR, immediately after the procedure and during follow up (FUP) were recorded. For statistical analysis, Student&#39;s T tests, Chi-square and non-parametric tests were performed when appropriate.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Mean age of the 25 included pts was 65.6&plusmn;12.5 years, 76% males. Ischemic heart disease was the most frequent etiology (52%, 13 pts) and the remainder had non-ischemic dilated cardiomyopathy. A total of 9 (36%) patients had CRT and 15 (60%) had ICD implanted before PMVR.&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Acute success rate was 96% and complications occurred in one pt (procedure failure due to ruptured chordae).&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">From baseline to FUP, NYHA functional class improved significantly (2.9&plusmn;0.7 vs 1.8&plusmn;0.6 vs 2.0&plusmn;0.6, p&lt;0.001), NT-proBNP decreased (5662&plusmn;7347 vs 3263&plusmn;2543 vs 2947&plusmn;1932 pg/mL, p=0.239) and there was a tendency to reduce furosemide dosage (66&plusmn;31mg vs 56&plusmn;25mg, p=0.084). We also observed improvement of RV function (RV strain -13.12&plusmn;-5 vs -13.4&plusmn;4, p=0.043; TAPSE 17&plusmn;4mm vs 21&plusmn;16, p=0.22). Additionally, there was a trend toward positive LV remodeling, with decreased LV end-diastolic volume (162&plusmn;72ml vs 158&plusmn;63ml, p=0.260), LV end-systolic volume (121&plusmn;61ml vs 115&plusmn;73ml, p=0.128) and improvement in LVEF (29&plusmn;9% vs 34&plusmn;12%, p=0.130).&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">On univariate analysis, PMVR had higher RV strain (p= 0.047) and lower NYHA functional class at baseline (p=0.013).</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In this study, PMVR in SMR led to a positive impact on symptoms, RV function and LV remodelling. Better RV function and lower functional class at baseline were the only predictors of MR improvement in those pts. Our findings support the notion that early referral of SMR to PMVR may lead to better outcomes.</span></span></span></p>