Open Access
Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598671
Oral Presentations
Sunday, February 12, 2017
DGTHG: Acquired Heart Valve Disease: Mitral Valve
Georg Thieme Verlag KG Stuttgart · New York

Mitraclip for High-Risk Patients with Significant Mitral Insufficiency: Shall We Unreservedly Recommend It?

R. Ostovar
1   Heart Center Brandenburg, Department of Cardiovascular Surgery, University Hospital of Medical School Brandenburg, Bernau bei Berlin, Germany
,
T. Claus
1   Heart Center Brandenburg, Department of Cardiovascular Surgery, University Hospital of Medical School Brandenburg, Bernau bei Berlin, Germany
,
M. Hartrumpf
1   Heart Center Brandenburg, Department of Cardiovascular Surgery, University Hospital of Medical School Brandenburg, Bernau bei Berlin, Germany
,
R.U. Kühnel
1   Heart Center Brandenburg, Department of Cardiovascular Surgery, University Hospital of Medical School Brandenburg, Bernau bei Berlin, Germany
,
M. Zytowski
1   Heart Center Brandenburg, Department of Cardiovascular Surgery, University Hospital of Medical School Brandenburg, Bernau bei Berlin, Germany
,
M. Laux
1   Heart Center Brandenburg, Department of Cardiovascular Surgery, University Hospital of Medical School Brandenburg, Bernau bei Berlin, Germany
,
J.M. Albes
1   Heart Center Brandenburg, Department of Cardiovascular Surgery, University Hospital of Medical School Brandenburg, Bernau bei Berlin, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

 
  All articles of this category

    Background: MitraClip is propagated for those high risk patients with mitral insufficiency, considered not qualifying for surgical repair. However, it is a palliative option only. A proportion of patients require consecutive surgical measures because of technical failure or inappropriate clinical improvement. Furthermore, surgical reconstruction of the valve is impossible in almost all patients after MitraClip implantation. Consequently, these patients end up with a mere replacement although repair may have been possible in the first place. We thus looked at the outcome of those patients compared with patients receiving primary mitral valve replacement (MVR) or mitral valve repair (MVP).

    Methods: Twenty-three patients were retrospectively analyzed after MVR following MitraClip between 2010 and 2016. Forty-six patients with corresponding demographic data and risk profile from the same period receiving primary MVR (23 patients) or MVP (23 patients) were retrieved for a matched pair analysis. Statistical analysis including Kaplan-Meyer survival was performed.

    Results: Mean age was 70 ±13.1 years in all groups, log. EuroSCORE was 23% ±17.3 in all groups. Preoperative LV-EF was 44% in MC, 48% in MVR, and 44% in MVP. Postop LV-EF was 48% in all groups. 30 day mortality was 21.7% in the MitraClip group whereas it was 4.3% in the MVR and 13.0% in the MVP group. 1-year survival was 56.5% in the MitraClip group while it was 95.6% in the MVR group and 82.6% in the MVP group (Wilcoxon Test all groups: p = 0.007; Chi2 Test: p = 0.001 MitraClip versus MVR; p = 0.054 MitraClip versus MVP).

    Conclusion: Patients who required surgical MVR after previous MitraClip fared worse than matched cohorts receiving primary MVR or MVP. Indication for MitraClip should therefore be made very cautiously in view of the excellent results gained with primary conventional surgery.


     

    No conflict of interest has been declared by the author(s).

      All articles of this category