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MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: mid-term results of a single-centre experience

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

De Bonis M, Taramasso M, Lapenna E, Denti P, La Canna G, Buzzatti N, Pappalardo F, Di Giannuario G, Cioni M, Giacomini A, Alfieri O

Reference

Eur J Cardiothorac Surg. 2016 Jan;49(1):255-62

Published

January 2016

Link

Read the abstract

My Comment

Background

The aim of this study was to compare MitraClip therapy with surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation.

Results

  • Single center report on 65 surgical edge-to-edge plus annuloplasty mitral valve repair versus 55 MitraClip patients operated on between 1999 and 2011.
  • Age (P = 0.005) and logistic European System for Cardiac Operative Risk Evaluation (P < 0.0001) were significantly higher in the MitraClip group.
  • Median follow-up was 4 years.
  • Hospital mortality was 3 vs 0% (P = 0.49) in the surgical and MitraClip groups. Survival at 4 years was similar in both groups (P = 0.9).
  • The length of hospital stay was 10 days for surgical repair and 5 days for MitraClip (P < 0.0001).
  • At 4 years freedom from moderate mitral regurgitation (74.9 ± 5.6% vs 51.4 ± 7.4%, P = 0.01) and freedom from severe mitral regurgitation (92.8 ± 3.4% vs 68.1 ± 7%, P = 0.002) were both significantly higher in the surgical group.
  • The use of MitraClip was identified as an independent predictor of recurrence of moderate (HR: 2.1, 95% CI: 1.1–3.9, P = 0.02) as well as of severe MR (HR: 6.1, 95% CI: 1.5–24.3, P = 0.01).

My comments

The MitraClip therapy is a safe and effective way to repair secondary MR in selected high-risk patients with relevant comorbidities. The surgical mitral valve repair seems to be more effective at follow-up. This mid-term follow-up study shows similar results in terms of in-hospital mortality and survival in MitraClip and surgical groups. However, since mitral valve after surgical repair remains competent for a longer time when compared with those treated with MitraClip, the future long-term follow-up study may show superiority of the surgical approach.

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