SPC365

Post-procedural mitral regurgitation as an independent predictor of morbidity and mortality outcomes

Session: Comunicações Orais - Sessão 02 - Intervenção não coronária
Speaker: Ana Rita Teixeira

Congress: CPC 2023
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 Rita Teixeira; Sofia Jacinto; João Ferreira Reis; Luísa Moura Branco; Pedro Rio; Ana Galrinho; António Fiarresga; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Background:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> The Mitraclip<sup>&reg;</sup> system is the most established percutaneous mitral valve intervention indicated for patients (pts) with severe mitral regurgitation non-eligible for surgery. Our aim was to identify clinical, echocardiographic, and </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">cardiopulmonary exercise testing<span style="background-color:white"> (CEPT) predictors of morbidity and mortality outcomes.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Methods:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> Retrospective single center analysis of all patients who underwent Mitraclip implant for secondary MR. Clinical, echocardiographic and CEPT variables were assessed at baseline, 1, 3 and 6 months after the procedure. Univariate analysis was performed followed by a multivariate Cox analysis to determine predictors for the primary (overall mortality) and secondary endpoints (overall mortality/ heart failure hospitalization). p &lt; than 0.05 were considered statistically significant.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Results:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> We included 51 pts (64.7% male, mean age 70&plusmn;14 years, mean follow-up time 14&plusmn;13 months, mean left ventricular ejection fraction </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">35<span style="background-color:white">&plusmn;9</span>%<span style="background-color:white">). NYHA class &ge;3 was present in 31 pts. MR grade IV was present in 72.5% and ischemic etiology in 47.1%. Successful implantation was achieved in 98%, with 33 (64,7%) pts presenting mild MR post-procedure. Overall mortality (M) was 31.4%, mostly due to cardiovascular causes, and 14 had at least one heart failure hospitalization (HFH). COAPT inclusion criteria was met in 22 </span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#404040">pts. Both post-procedural MR (p=0</span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">.008) and mitral gradient (p=0.039) were predictors of M. Although not statistically significant, non-ischemic etiology </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">(HR 0.24, 95% CI: 0.069-1.008, p=0.051) <span style="background-color:white">had a borderline p-value for predicting M. In the multivariate analysis moderate to severe post-procedural MR was as independent predictor of M (p=0.041). COAPT criteria (p=0.048), moderate to severe post-procedural MR (p=0.015) and TAPSE/PASP ratio &le;0.36 (p=0.043) were predictors of M/HF, being post-procedural moderate-severe MR an independent one (p=0.020).</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusion:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> In our population, moderate to severe post-procedural mitral regurgitation was an independent predictor of overall mortality and mortality/HF hospitalization. Patients with COAPT inclusion criteria had also better outcomes. </span></span></span></span></span></span></p>