Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy
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Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy. / Rudolph, Volker; Huntgeburth, Michael; von Bardeleben, Ralph Stephan; Boekstegers, Peter; Lubos, Edith; Schillinger, Wolfgang; Ouarrak, Taoufik; Eggebrecht, Holger; Butter, Christian; Plicht, Björn; May, Andreas; Franzen, Olaf; Schofer, Joachim; Senges, Jochen; Baldus, Stephan.
in: EUR J HEART FAIL, Jahrgang 16, Nr. 11, 11.2014, S. 1223-1229.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy
AU - Rudolph, Volker
AU - Huntgeburth, Michael
AU - von Bardeleben, Ralph Stephan
AU - Boekstegers, Peter
AU - Lubos, Edith
AU - Schillinger, Wolfgang
AU - Ouarrak, Taoufik
AU - Eggebrecht, Holger
AU - Butter, Christian
AU - Plicht, Björn
AU - May, Andreas
AU - Franzen, Olaf
AU - Schofer, Joachim
AU - Senges, Jochen
AU - Baldus, Stephan
N1 - © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.
PY - 2014/11
Y1 - 2014/11
N2 - 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.
AB - 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.
KW - Aged
KW - Critical Illness
KW - Echocardiography
KW - Female
KW - Germany/epidemiology
KW - Heart Valve Prosthesis Implantation/methods
KW - Humans
KW - Length of Stay/statistics & numerical data
KW - Male
KW - Mitral Valve Insufficiency/diagnostic imaging
KW - Percutaneous Coronary Intervention
KW - Postoperative Complications/mortality
KW - Prevalence
KW - Prospective Studies
KW - Quality of Life
KW - Registries
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Survival Rate
KW - Treatment Outcome
U2 - 10.1002/ejhf.169
DO - 10.1002/ejhf.169
M3 - SCORING: Journal article
C2 - 25314900
VL - 16
SP - 1223
EP - 1229
JO - EUR J HEART FAIL
JF - EUR J HEART FAIL
SN - 1388-9842
IS - 11
ER -
