Long-term survival and preprocedural predictors of mortality in high surgical risk patients undergoing percutaneous mitral valve repair.
OBJECTIVE
To evaluate long-term survival in high surgical risk patients undergoing percutaneous mitral valve repair (MVR) using the MitraClip(®) system and to identify preprocedural predictors of long-term mortality.


BACKGROUND
Data for long-term survival and preprocedural predictors of mortality after percutaneous MVR in high surgical risk patients are sporadic.


METHODS
From January 2009 to April 2013, 136 consecutive high surgical risk patients, with symptomatic moderate-to-severe or severe mitral regurgitation (MR), underwent percutaneous MVR using the MitraClip system. Cardiac and overall survival was determined at one and 2 years postprocedure. Univariate and multivariate analysis was performed to identify preprocedural predictors of long-term mortality.


RESULTS
One year postprocedure, cardiac and overall survival was 86.7% and 84.6%, respectively and at 2 years cardiac and overall survival was 77.7% and 74.8%, respectively. In univariate analysis advanced age, lower body mass index, impaired renal function, elevated levels of log-N-terminal-pro-brain-natriuretic-peptide (log-NTproBNP), poor performance in functional tests (New York Heart Association (NYHA) class) and high logistic Euroscore (LES) and Society of Thoracic Surgeons (STS) score were identified as preprocedural predictors of long-term cardiac mortality. In multivariate analysis preoperative NYHA class III and IV, elevated levels of log-NTproBNP and advanced age predicted long-term cardiac mortality.


CONCLUSIONS
Percutaneous MVR using the MitraClip system has favorable long-term survival rates in high surgical risk patients. Preprocedural NYHA functional class III and IV, elevated log-NTproBNP levels and advanced age predict higher long-term cardiac mortality and should be considered during patient selection.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Andreas S
AS
Triantafyllis
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Friso
F
Kortlandt
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Annelies L M
AL
Bakker
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Martin J
MJ
Swaans
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Frank D
FD
Eefting
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Jan A S
JA
van der Heyden
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Martijn C
MC
Post
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Benno W J M
BW
Rensing
D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
mitral valve disease-edge to edge repair