MitraClip in secondary mitral regurgitation as a bridge to heart transplantation: 1-year outcomes from the International MitraBridge Registry
Por:
Godino, C, Munafo, A, Scotti, A, Estevez-Loureiro, R, Hernandez, AP, Arzamendi, D, Peregrina, EF, Taramasso, M, Fam, NP, Ho, EC, Asgar, A, Vitrella, G, Raineri, C, Adamo, M, Fiorina, C, Montalto, C, Fraccaro, C, Giannini, C, Fiorelli, F, Rubbio, AP, Ooms, JF, Compagnone, M, Maffeo, D, Bettari, L, Furholz, M, Tamburino, C, Petronio, AS, Grasso, C, Agricola, E, Van Mieghem, NM, Tarantini, G, Curello, S, Praz, F, Pascual, I, Potena, L, Colombo, A, Maisano, F, Metra, M, Margonato, A, Crimi, G, Saia, F
Publicada:
1 dic 2020
Resumen:
BACKGROUND: Patients awaiting heart transplantation (HTx) often need bridging therapies to reduce worsening and progression of underlying disease. Limited data are available regarding the use of the MitraClip procedure in secondary mitral regurgitation for this clinical condition.
METHODS: We evaluated an international, multicenter (17 centers) registry including 119 patients (median age: 58 years) with moderate-to-severe or severe secondary mitral regurgitation and advanced heart failure (HF) (median left ventricular ejection fraction: 26%) treated with MitraClip as a bridge strategy according to 1 of the following criteria: (1) patients active on HTx list (in list group) (n = 31); (2) patients suitable for HTx but awaiting clinical decision (bridge to decision group) (n = 54); or (3) patients not yet suitable for HTx because of potentially reversible relative contraindications (bridge to candidacy group) (n = 34).
RESULTS: Procedural success was achieved in 87.5% of cases, and 30-day survival was 100%. At 1 year, Kaplan-Meier estimates of freedom from the composite primary end-point (death, urgent HTx or left ventricular assist device implantation, first rehospitalization for HF) was 64%. At the time of last available follow-up (median: 532 days), 15% of patients underwent elective transplant, 15.5% remained or could be included in the HTx waiting list, and 23.5% had no more indication to HTx because of clinical improvement.
CONCLUSIONS: MitraClip procedure as a bridge strategy to HTx in patients with advanced HF with significant mitral regurgitation was safe, and two thirds of patients remained free from adverse events at 1 year. These findings should be considered exploratory and hypothesis-generating to guide further study for percutaneous intervention in high-risk patients with advanced HF. (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.
Filiaciones:
Godino, C:
Ist Sci San Raffaele, Cardio Thorac Vasc Dept, Milan, Italy
Munafo, A:
Ist Sci San Raffaele, Cardio Thorac Vasc Dept, Milan, Italy
Scotti, A:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Med Sch, Padua, Italy
Estevez-Loureiro, R:
Univ Hosp Puerta Hierro Majadahonda, Dept Cardiol, Madrid, Spain
Hernandez, AP:
Univ Hosp Puerta Hierro Majadahonda, Dept Cardiol, Madrid, Spain
Arzamendi, D:
Univ Autonoma Barcelona, Intment Cardiol Unit, Hosp Santa Creu & St Pau, Cardiol Dept, Barcelona, Spain
Peregrina, EF:
Univ Autonoma Barcelona, Intment Cardiol Unit, Hosp Santa Creu & St Pau, Cardiol Dept, Barcelona, Spain
Taramasso, M:
Univ Zurich, Univ Hosp Zurich, Clin Heart & Vasc Surg, Zurich, Switzerland
Fam, NP:
St Michaels Hosp, Div Cardiol, Toronto, ON, Canada
Ho, EC:
St Michaels Hosp, Div Cardiol, Toronto, ON, Canada
Asgar, A:
Univ Montreal, Intervent Cardiol Unit, Montreal Heart Inst, Montreal, PQ, Canada
Vitrella, G:
Azienda Sanitaria Univ Integrata Trieste, Cardiovasc Dept, Trieste, Italy
Raineri, C:
Fdn IRCCS Policlin San Matteo Fdn, Div Cardiol, Pavia, Italy
Adamo, M:
Spedali Civili Brescia, Catheterizat Lab, Cardiothorac Dept, Brescia, Italy
Fiorina, C:
Spedali Civili Brescia, Catheterizat Lab, Cardiothorac Dept, Brescia, Italy
Montalto, C:
Fdn IRCCS Policlin San Matteo Fdn, Div Cardiol, Pavia, Italy
Fraccaro, C:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Med Sch, Padua, Italy
Giannini, C:
Univ Pisa, Dept Anesthesia & Intens Care, Cardiac Thorac & Vasc Dept, Pisa, Italy
Fiorelli, F:
Univ Pisa, Dept Anesthesia & Intens Care, Cardiac Thorac & Vasc Dept, Pisa, Italy
Rubbio, AP:
Azienda Ospedaliero Univ Policlin Vittorio Emanue, Div Cardiol, Cardio Thorac Vasc Dept, Catania, Italy
Ooms, JF:
Erasmus MC, Dept Cardiol Thoraxctr, Rotterdam, Netherlands
Compagnone, M:
Univ Hosp Bologna, Cardio Thoraco Vasc Dept, Cardiol Unit, Policlin S Orsola Malpighi, Bologna, Italy
Maffeo, D:
Fdn Poliambulanza Ist Ospedaliero, Cardiovasc Dept, Brescia, Italy
Bettari, L:
Fdn Poliambulanza Ist Ospedaliero, Cardiovasc Dept, Brescia, Italy
Furholz, M:
Univ Bern, Bern Univ Hosp Inselspital, Dept Cardiol, Bern, Switzerland
Tamburino, C:
Azienda Ospedaliero Univ Policlin Vittorio Emanue, Div Cardiol, Cardio Thorac Vasc Dept, Catania, Italy
Petronio, AS:
Univ Pisa, Dept Anesthesia & Intens Care, Cardiac Thorac & Vasc Dept, Pisa, Italy
Grasso, C:
Azienda Ospedaliero Univ Policlin Vittorio Emanue, Div Cardiol, Cardio Thorac Vasc Dept, Catania, Italy
Agricola, E:
Ist Sci San Raffaele, Cardio Thorac Vasc Dept, Milan, Italy
Van Mieghem, NM:
Erasmus MC, Dept Cardiol Thoraxctr, Rotterdam, Netherlands
Tarantini, G:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Med Sch, Padua, Italy
Curello, S:
Spedali Civili Brescia, Catheterizat Lab, Cardiothorac Dept, Brescia, Italy
Praz, F:
Univ Bern, Bern Univ Hosp Inselspital, Dept Cardiol, Bern, Switzerland
Pascual, I:
Hosp Univ Cent Asturias HUCA, Intervent Cardiol Unit, Oviedo, Spain
Potena, L:
Univ Hosp Bologna, Cardio Thoraco Vasc Dept, Cardiol Unit, Policlin S Orsola Malpighi, Bologna, Italy
Colombo, A:
Ist Sci San Raffaele, Cardio Thorac Vasc Dept, Milan, Italy
Maisano, F:
Univ Zurich, Univ Hosp Zurich, Clin Heart & Vasc Surg, Zurich, Switzerland
Metra, M:
Spedali Civili Brescia, Catheterizat Lab, Cardiothorac Dept, Brescia, Italy
Margonato, A:
Ist Sci San Raffaele, Cardio Thorac Vasc Dept, Milan, Italy
Crimi, G:
Univ Genoa, Intervent Cardiol Unit, Cardio Thoraco Vasc Dept DICATOV, AOU San Martino IST,IRCCS, Genoa, Italy
Saia, F:
Univ Hosp Bologna, Cardio Thoraco Vasc Dept, Cardiol Unit, Policlin S Orsola Malpighi, Bologna, Italy
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