Impact of left ventricular systolic dysfunction on the outcomes of percutaneous edge-to-edge mitral valve repair using MitraClip

• Published in: Heart and vessels Vol. 31; no. 12; pp. 1988 - 1996
• Main Authors: Kaneko, Hidehiro, Neuss, Michael, Schau, Thomas, Weissenborn, Jens, Butter, Christian
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.12.2016; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Databases, Factual; Echocardiography, Transesophageal; Female; Guidelines; Heart surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Natriuretic Peptide, Brain - blood; Original Article; Peptide Fragments - blood; Prosthesis Design; Retrospective Studies; Severity of Illness Index; Systole; Time Factors; Treatment Outcome; Vascular Surgery; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; Percutaneous edge-to-edge mitral valve repair; Left ventricular dysfunction; MitraClip; Left ventricular ejection fraction
• ISSN: 0910-8327; 1615-2573; 1615-2573
• DOI: 10.1007/s00380-016-0822-1

Left ventricular systolic dysfunction (LVD) is associated with poor outcomes after mitral regurgitation (MR) surgery. MitraClip (MC) is a novel treatment option for MR patients with a high surgical risk. However, outcomes of LVD patients underwent MC remain unclear. In total of 194 patients after MC implantation, 75 patients (39 %) had severe LVD (LV ejection fraction ≤30 %). Patients with severe LVD were primarily male and also younger. Logistic euroSCOREs were comparable between the two groups. Functional MR was more common in patients with severe LVD, while New York Heart Association (NYHA) class was similar between the two groups. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was significantly higher in patients with LVD. In addition to similar improvements in MR severity, NYHA class, and NT-proBNP levels, the survival rates were not different between patients with and without severe LVD. Among patients with severe LVD, the long-term survival rates were significantly lower in patients aged ≥75 years, those with NT-proBNP >5000 pg/mL, and those with atrial fibrillation (AF). In conclusion, severe LVD was not associated with the mortality after MC implantation. MC might be feasible and effective even in the patients with severe MR and low LVEF. However, we need to carefully observe severe LVD patients who are elderly, have a high NT-proBNP level, and have AF, as these might be considered high-risk subjects.