A heart team's perspective on interventional mitral valve repair: percutaneous clip implantation as an important adjunct to a surgical mitral valve program for treatment of high-risk patients
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A heart team's perspective on interventional mitral valve repair: percutaneous clip implantation as an important adjunct to a surgical mitral valve program for treatment of high-risk patients. / Treede, Hendrik; Schirmer, Johannes; Rudolph, Volker; Franzen, Olaf; Knap, Malgorzata; Schluter, Michael; Conradi, Lenard; Seiffert, Moritz; Koschyk, Dietmar; Meinertz, Thomas; Baldus, Stephan; Reichenspurner, Hermann.
In: J THORAC CARDIOV SUR, Vol. 143, No. 1, 01.2012, p. 78-84.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - A heart team's perspective on interventional mitral valve repair: percutaneous clip implantation as an important adjunct to a surgical mitral valve program for treatment of high-risk patients
AU - Treede, Hendrik
AU - Schirmer, Johannes
AU - Rudolph, Volker
AU - Franzen, Olaf
AU - Knap, Malgorzata
AU - Schluter, Michael
AU - Conradi, Lenard
AU - Seiffert, Moritz
AU - Koschyk, Dietmar
AU - Meinertz, Thomas
AU - Baldus, Stephan
AU - Reichenspurner, Hermann
N1 - Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
PY - 2012/1
Y1 - 2012/1
N2 - OBJECTIVE: Surgical mitral valve repair carries an elevated perioperative risk in the presence of severely reduced ventricular function and relevant comorbidities. We sought to assess the feasibility of catheter-based mitral valve repair using a clip-based percutaneous edge-to-edge repair system in selected patients at high surgical risk with mitral regurgitation grade 3 or worse.METHODS: Between 2002 and January 2011, 202 consecutive patients without prior mitral valve surgery (age 75 ± 9 years; 63% were male) with symptomatic functional (65%), degenerative (27%), or mixed (8%) mitral regurgitation were treated with a percutaneous clip system for approximation of the anterior and posterior mitral leaflets. Risk for mitral valve surgery was considered high in terms of a mean logistic European System for Cardiac Operative Risk Evaluation of 44% (range, 21%-54%). Preprocedural left ventricular ejection fraction was 35% or less in 36% of patients. An interdisciplinary heart team of cardiologists and cardiac surgeons discussed all patients.RESULTS: Percutaneous clip implantation was successful in 186 patients (92%). Patients were treated with 1 clip (n = 125; 62%), 2 clips (n = 64; 32%), or 3 or more clips (n = 7; 3%). Reduction in mitral regurgitation from pre- to postprocedure was significant (P < .0001) and remained stable within the first 12 months in the majority of patients. Thirty-day mortality was 3.5% (7/202 patients). Hospital stay was 12 ± 10 days, and median intensive care unit stay was 1 day (range, 0-45 days). Eleven patients required surgical valve repair/replacement at a median of 38 days (0-468 days) after percutaneous clip implantation.CONCLUSIONS: Clip-based percutaneous mitral valve repair is a safe, low-risk, and effective therapeutic option in symptomatic patients with a high risk for surgery and does not exclude later surgical repair.
AB - OBJECTIVE: Surgical mitral valve repair carries an elevated perioperative risk in the presence of severely reduced ventricular function and relevant comorbidities. We sought to assess the feasibility of catheter-based mitral valve repair using a clip-based percutaneous edge-to-edge repair system in selected patients at high surgical risk with mitral regurgitation grade 3 or worse.METHODS: Between 2002 and January 2011, 202 consecutive patients without prior mitral valve surgery (age 75 ± 9 years; 63% were male) with symptomatic functional (65%), degenerative (27%), or mixed (8%) mitral regurgitation were treated with a percutaneous clip system for approximation of the anterior and posterior mitral leaflets. Risk for mitral valve surgery was considered high in terms of a mean logistic European System for Cardiac Operative Risk Evaluation of 44% (range, 21%-54%). Preprocedural left ventricular ejection fraction was 35% or less in 36% of patients. An interdisciplinary heart team of cardiologists and cardiac surgeons discussed all patients.RESULTS: Percutaneous clip implantation was successful in 186 patients (92%). Patients were treated with 1 clip (n = 125; 62%), 2 clips (n = 64; 32%), or 3 or more clips (n = 7; 3%). Reduction in mitral regurgitation from pre- to postprocedure was significant (P < .0001) and remained stable within the first 12 months in the majority of patients. Thirty-day mortality was 3.5% (7/202 patients). Hospital stay was 12 ± 10 days, and median intensive care unit stay was 1 day (range, 0-45 days). Eleven patients required surgical valve repair/replacement at a median of 38 days (0-468 days) after percutaneous clip implantation.CONCLUSIONS: Clip-based percutaneous mitral valve repair is a safe, low-risk, and effective therapeutic option in symptomatic patients with a high risk for surgery and does not exclude later surgical repair.
KW - Aged
KW - Aged, 80 and over
KW - Attitude of Health Personnel
KW - Cardiac Surgical Procedures/methods
KW - Decision Trees
KW - Feasibility Studies
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Mitral Valve/surgery
KW - Mitral Valve Insufficiency/surgery
KW - Patient Care Team
KW - Prospective Studies
KW - Prosthesis Implantation/methods
KW - Risk Factors
U2 - 10.1016/j.jtcvs.2011.09.033
DO - 10.1016/j.jtcvs.2011.09.033
M3 - SCORING: Journal article
C2 - 22036261
VL - 143
SP - 78
EP - 84
JO - J THORAC CARDIOV SUR
JF - J THORAC CARDIOV SUR
SN - 0022-5223
IS - 1
ER -
