Cor Vasa 2019, 61(1):8-14 | DOI: 10.1016/j.crvasa.2018.07.006

MitraClip in patients with functional mitral regurgitation and advanced heart failure - Single centre experience

Aleš Benák, Blanka Skalická, Jana Hašková, Martin Kotrč, Radka Kočková, Vladimír Pořízka, Michael Želízko, Josef Kautzner, Vojtěch Melenovský
Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

Aim: Chronic heart failure with left ventricular (LV) dysfunction is often associated with functional mitral regurgitation (MiR). This may be ameliorated, mitral valve morphology permitting, by implanting a MitraClip. Registry data demonstrate a positive effect on symptoms. A decrease in mortality and shorter hospitalisation for heart failure are currently the subjects of randomised studies. The aim of the work presented here is to describe our experience with this therapeutic approach.

Methods and results: Since 2014, MitraClip has been implanted at our clinic in 30 patients with significant functional MiR and LV systolic dysfunction (DCM 60%, IHD 26%, LV EF 29 ± 6%, NYHA ≥ 3 84%). The procedure was technically successful in 97% of cases, periprocedural and 90-day mortality being zero and the incidence of serious complications minimal. Twelve months after implantation, the following changes were demonstrated (paired t-test, p < 0.05): improvement in NYHA functional class (2.8 ± 0.3 vs. 2.3 ± 0.2), improvement in quality of life according to Kansas and Minnesota questionnaires (Kansas City Cardiomyopathy Questionnaire [KCCQ] overall summary 58 ± 27 vs. 69 ± 23, Minnesota Living With Heart Failure Questionnaire [MLHFQ] score 36 ± 23 vs. 26 ± 13), increase in both systolic (113 ± 15 vs. 119 ± 12 mmHg) and diastolic (68 ± 11 vs. 75 ± 9 mmHg) blood pressure, a rise in haemoglobin levels (130 ± 21 vs. 138 ± 17 g/l), MiR reduction (3.6 ± 0.4 vs. 2.2 ± 0.6), left ventricular mass reduction (139 ± 35 vs. 129 ± 29 g/m2) and a trend towards improvement of right ventricular function. Annual mortality was 10%, hospitalisation for heart failure was 30% and 2 patients were indicated for heart transplantation.

Conclusion: Our experience shows that MitraClip implantation improves both symptoms and quality of life in selected patients with heart failure, systolic LV dysfunction and functional MiR. This method broadens the treatment options for patients who cannot undergo surgical repair because of valve defect characteristics and LV dysfunction.

Keywords: Functional mitral regurgitation, Heart failure with left ventricular dysfunction, MitraClip

Published: March 21, 2019  Show citation

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Benák A, Skalická B, Hašková J, Kotrč M, Kočková R, Pořízka V, et al.. MitraClip in patients with functional mitral regurgitation and advanced heart failure - Single centre experience. Cor Vasa. 2019;61(1):8-14. doi: 10.1016/j.crvasa.2018.07.006.
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