SPC365

Mitral transcatheter edge-to-edge repair: 10-year experience from a tertiary care center

Session: Sessão de Posters 54 - Intervenção valvular mitral
Speaker: Francisco Barbas de Albuquerque

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Francisco Barbas De Albuquerque; Miguel Abrantes Figueiredo; Vera Ferreira; António Fiarresga; Rúben Ramos; João Pedro Reis; Ana Teresa Timóteo; Pedro Rio; Ana Galrinho; Luís Moura Branco; Duarte Cacela; Rui Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Mitral regurgitation (MR) is a common valvulopathy and is associated with poor prognosis. Mitral transcatheter edge-to-edge repair (TEER) have emerged as a therapeutic approach for both primary and secondary MR in selected patients. This technique is associated with improvement in clinical outcomes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Aim</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">To describe patients&rsquo; characteristics and clinical outcomes of mitral TEER intervention in our tertiary center.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Single center prospective analysis of consecutive patients with both primary and functional MR submitted to mitral TEER, between 2013 and 2023. Clinical, demographic, laboratory and echocardiographic data were collected through clinical records according to our institutional protocol. Clinical outcomes of interest were assessed by Kaplan-Meier curves. IBM SPSS Statistics 26 was used.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Seventy-six patients were implanted MitraClip &reg; device during the ten-year period. Regarding MR etiology, 19 were primary and 57 were secondary. &nbsp;Figure 1 illustrate the main baseline characteristics of our study population, divided by MR etiology.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">In patients with primary MR, mean regurgitant volume (RV) was 61 &plusmn; 19 mL, mean effective regurgitant orifice area (EROA) was 41 &plusmn; 11 mm<sup>2</sup>, mean mitral valve (MV) mean gradient (MG) &nbsp;was 2.9 &plusmn; 1 mmHg and mean systolic pulmonary artery pressure was 50 &plusmn; 11 mmHg. Regarding secondary MR patients, mean left ventricle (LV) ejection fraction was 34 &plusmn; 10%, mean RV was 53 &plusmn; 22 mL, mean EROA was 39 &plusmn; 16 mm2, mean end-systolic LV dimension was 54 &plusmn; 11 mm and mean end-diastolic LV volume was 118 &plusmn; 47 mL/m<sup>2</sup>.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Overall, immediate implantation success was achieved in 89% of procedures. Device-related complications occurred in 10 patients: 5 had cordae rupture, 3 had device partial detachment and 2 had leaflet perforation. Regarding clinical complications, 1 patient had cardiac arrest, 1 had emergent cardiac surgery, 2 had a stroke and 3 had vascular complications.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Before discharge, MR &le; 2+ was achieved in 87% of patients and 65 (86%) patients had MV MG &le; 5 mmHg.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At 30-days, all-cause mortality incidence was 5% (n=4) and heart failure (HF) hospitalisations (HFH) incidence was 8% (n=6).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At 1 year follow-up, all-cause mortality incidence was 17% (n=13) and HFH incidence was 26% (n=20).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">During a total median follow-up time per patient of 2.1 years, the all-cause mortality incidence was 34% (n=26). No differences in all cause-mortality were observed between MR etiology (HR 1.25, 95% CI 0.5-3) (Figure 1.) Furthermore, 1 patient was submitted to mitral valve surgery and 2 patients received heart transplanted during follow-up.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Mitral TEER was a feasible and safe procedure in patients with both primary and secondary severe MR. Immediate success was achieved in most patients. Clinical outcomes at 30 days, 1 year and longer-term were satisfactory and no differences in all-cause mortality between primary and secondary MR were observed.</span></span></p>