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Outcomes after transcatheter edge-to-edge repair of primary mitral regurgitation – a single-centre experience
Session:
Posters (Sessão 2 - Écran 4) - Doença valvular
Speaker:
Diogo Santos Ferreira
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Diogo Santos Ferreira; Fabiana Duarte; Silvia Diaz; Cláudio Guerreiro; Mariana Brandão; Fábio Nunes; Rafael Teixeira; Eulália Pereira; Francisco Sampaio; Lino Santos; Alberto Rodrigues; Pedro Braga; Gustavo Pires-Morais; Bruno Melica; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">BACKGROUND: Mitral regurgitation (MR) is the second-most frequent valvular disease in Europe, with prognostic implications. Although mitral transcatheter-edge-to-edge repair (TEER) should be considered in selected severe secondary MR patients, with demonstrated benefits over follow-up, percutaneous intervention of primary MR (PMR) may be considered in inoperable cases, for which there is a lack of consistent evidence regarding improvement of outcomes.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">PURPOSE: Characterize the population undergoing TEER for PMR, respective clinical and echocardiographic response, and outcomes over follow-up.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS: All mitral TEER procedures for PMR conducted in a single-centre between 2015 and 2021 were retrospectively analyzed. The primary endpoint was defined as a composite of all-cause mortality or first heart failure (HF) hospitalization after intervention. Clinical, echocardiographic and blood-analysis data were assessed and explored as characteristics associated with the endpoint defined, using Pearson’s Chi-squared test, Wilcoxon rank sum test and Fisher’s exact test, as appropriate. <em>p</em><0.05 was considered statistically significant.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS: Thirty-seven patients with PMR were treated, with a median follow-up of 27 months. Mean age was 78 years-old, with a slight predominance of male sex (59%). Mean EuroSCORE II was 4.30±3.0. About 24% of cases presented with a mixed MR, with a predominant primary etiology. The most common mechanism for PMR was prolapse (58%), followed by flail (27%) and calcification (12%), more frequently involving the posterior leaflet (56%), with a mean MR graded at 3.8 (1-4) . Functional success after intervention was achieved in 95% of cases. There was no intra- or immediate post-intervention mortality. One patient suffered from a major acess site vascular complication, namely formation of arteriovenous fistula. Two patients (5%) died over the first 12 months, both about 8 months after TEER. One patient was hospitalized for HF in the first year, over the second month of follow-up. Primary endpoint occurred in 51% of patients over a median follow-up of 27 months. After one year of intervention, 65% of patients presented an improvement of at least 1 New York Heart Association (NYHA) HF class, and mean MR was graded at 2.3 (1-4). There was a statistically significant higher estimated STS morbimortality score, a higher frequency of atrial fibrillation and more frequent MR grade ≥2 at discharge among patients reaching the primary endpoint.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSIONS: TEER for PMR is a safe and effective intervention in reducing MR in selected patients, with few severe adverse events over the first year, and two-thirds presenting an improvement in HF functional capacity in this period. Mortality and HF hospitalization remains very frequent in the medium-term in this high-risk populations, occurring in half of patients over a median follow-up of 27 months.</span></span></p>
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