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Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy.

Abstract：

AIMS:As periprocedural risk is low, MitraClip implantation is often performed in critically ill, not fully recompensated patients, who are in NYHA functional class IV at the time of the procedure, to accelerate convalescence. We herein sought to evaluate the procedural and 30-day outcome of this patient group. METHODS AND RESULTS:A total of 803 patients undergoing MitraClip implantation were included in the German Mitral Valve Registry, and 30-day outcomes were prospectively assessed. Patients were separated based on NYHA functional class [(NYHA IV (n = 143), III (n = 572), and I/II (n = 88)]. No difference was noted in co-morbities and echocardiographic parameters of LV function between groups. However, parameters of severity of mitral regurgitation (MR) were higher in NYHA IV patients. High procedural success rates and low residual MR grades at discharge were observed throughout all groups. In-hospital major adverse cardiac events were similar between groups. Importantly, 30-day mortality (8.0% vs. 3.2% vs. 4.8%; P < 0.05) was significantly higher in NYHA IV patients, whereas rehospitalization did not differ between groups. At 30 days, 47.6% of NYHA IV patients were still in NYHA class III or IV compared with 32.5% and 14.8% in the other groups (P < 0.05), although NYHA functional class decreased in 69% of patients. Quality of life, which was very poor at baseline, showed an overall improvement in NYHA IV patients after 30 days, with, for example, a reduction of bed-ridden patients from 19.6% to 3.3%. CONCLUSION:MitraClip therapy is feasible and safe even in critically ill, not fully recompensated patients and leads to symptomatic improvement in over two-thirds of these patients; however, it is associated with an elevated 30-day mortality.

journal_name

Eur J Heart Fail

journal_title

European journal of heart failure

authors

Rudolph V,Huntgeburth M,von Bardeleben RS,Boekstegers P,Lubos E,Schillinger W,Ouarrak T,Eggebrecht H,Butter C,Plicht B,May A,Franzen O,Schofer J,Senges J,Baldus S

doi

10.1002/ejhf.169

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

1223-9

issue

eissn

1388-9842

issn

1879-0844

journal_volume

pub_type

杂志文章,多中心研究

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Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy.