MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome

Edith Lubos; Michael Schlüter; Eik Vettorazzi; Britta Goldmann; Daniel Lubs; Johannes Schirmer; Hendrik Treede; Hermann Reichenspurner; Stefan Blankenberg; Stephan Baldus; Volker Rudolph

doi:10.1016/j.jcin.2013.12.198

MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome

Standard

MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome. / Lubos, Edith; Schlüter, Michael; Vettorazzi, Eik; Goldmann, Britta; Lubs, Daniel ; Schirmer, Johannes ; Treede, Hendrik ; Reichenspurner, Hermann ; Blankenberg, Stefan; Baldus, Stephan; Rudolph, Volker.

In: JACC-CARDIOVASC INTE, Vol. 7, No. 4, 01.04.2014, p. 394-402.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Lubos, E, Schlüter, M, Vettorazzi, E, Goldmann, B, Lubs, D , Schirmer, J , Treede, H , Reichenspurner, H , Blankenberg, S, Baldus, S & Rudolph, V 2014, 'MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome', JACC-CARDIOVASC INTE, vol. 7, no. 4, pp. 394-402. https://doi.org/10.1016/j.jcin.2013.12.198

APA

Lubos, E., Schlüter, M., Vettorazzi, E., Goldmann, B., Lubs, D., Schirmer, J., Treede, H., Reichenspurner, H., Blankenberg, S., Baldus, S., & Rudolph, V. (2014). MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome. JACC-CARDIOVASC INTE, 7(4), 394-402. https://doi.org/10.1016/j.jcin.2013.12.198

Vancouver

Lubos E, Schlüter M, Vettorazzi E, Goldmann B, Lubs D , Schirmer J et al. MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome. JACC-CARDIOVASC INTE. 2014 Apr 1;7(4):394-402. https://doi.org/10.1016/j.jcin.2013.12.198

Bibtex

@article{9d0d1eebe05e4f25b9090fcd37bcb524,

title = "MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome",

abstract = "OBJECTIVES: The aim of the study was to assess predictors of acute procedural failure in surgical high-risk patients undergoing MitraClip (Abbott Vascular, Abbott Park, Illinois) therapy.BACKGROUND: MitraClip implantation is a novel percutaneous option to treat significant mitral regurgitation (MR).METHODS: In 300 patients (75 ± 9 years of age, 190 [63%] men), of whom 32 (10.7%) had been unsuccessfully treated (discharge MR grade of >2+), baseline clinical and echocardiographic variables were evaluated by exact logistic regression and classification tree analyses to assess their impact on acute procedural failure. Acute procedural failure was differentiated into aborted procedure (no MitraClip implanted; n = 11) and {"}clip failure{"} (inadequate MR reduction despite MitraClip implantation; n = 21).RESULTS: Multivariate logistic regression identified effective regurgitant orifice area (EROA), mitral valve orifice area (MVOA), and mean transmitral pressure gradient (TMPG) as independent predictors of overall acute procedural failure. Classification tree analysis revealed that an EROA >70.8 mm(2) (n = 28) was associated with a high rate (25%) of clip failures, whereas the combination of an MVOA ≤3.0 cm(2) and a TMPG ≥4 mm Hg (n = 16) was associated with a high rate (37.5%) of aborted procedures. Failure rates of ≤10% were observed in all patients with an EROA ≤70.8 mm(2) and either an MVOA >3.0 cm(2) (n = 217) or an MVOA ≤3.0 cm(2) in concert with a TMPG ≤3 mm Hg (n = 39). Multinomial logistic regression identified an EROA >70.8 mm(2) and a TMPG ≥4 mm Hg as independently predictive of clip failure, but an MVOA ≤3.0 cm(2) and a TMPG ≥4 mm Hg as independently predictive of procedure abortion.CONCLUSIONS: In surgical high-risk patients undergoing MitraClip therapy, a TMPG ≥4 mm Hg, an EROA ≥70.8 mm(2), and an MVOA ≤3.0 cm(2) carry an increased risk of procedural failure.",

author = "Edith Lubos and Michael Schl{\"u}ter and Eik Vettorazzi and Britta Goldmann and Daniel Lubs and Johannes Schirmer and Hendrik Treede and Hermann Reichenspurner and Stefan Blankenberg and Stephan Baldus and Volker Rudolph",

year = "2014",

month = apr,

day = "1",

doi = "10.1016/j.jcin.2013.12.198",

language = "English",

volume = "7",

pages = "394--402",

journal = "JACC-CARDIOVASC INTE",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "4",

}

RIS

TY - JOUR

T1 - MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome

AU - Lubos, Edith

AU - Schlüter, Michael

AU - Vettorazzi, Eik

AU - Goldmann, Britta

AU - Lubs, Daniel

AU - Schirmer, Johannes

AU - Treede, Hendrik

AU - Reichenspurner, Hermann

AU - Blankenberg, Stefan

AU - Baldus, Stephan

AU - Rudolph, Volker

PY - 2014/4/1

Y1 - 2014/4/1

N2 - OBJECTIVES: The aim of the study was to assess predictors of acute procedural failure in surgical high-risk patients undergoing MitraClip (Abbott Vascular, Abbott Park, Illinois) therapy.BACKGROUND: MitraClip implantation is a novel percutaneous option to treat significant mitral regurgitation (MR).METHODS: In 300 patients (75 ± 9 years of age, 190 [63%] men), of whom 32 (10.7%) had been unsuccessfully treated (discharge MR grade of >2+), baseline clinical and echocardiographic variables were evaluated by exact logistic regression and classification tree analyses to assess their impact on acute procedural failure. Acute procedural failure was differentiated into aborted procedure (no MitraClip implanted; n = 11) and "clip failure" (inadequate MR reduction despite MitraClip implantation; n = 21).RESULTS: Multivariate logistic regression identified effective regurgitant orifice area (EROA), mitral valve orifice area (MVOA), and mean transmitral pressure gradient (TMPG) as independent predictors of overall acute procedural failure. Classification tree analysis revealed that an EROA >70.8 mm(2) (n = 28) was associated with a high rate (25%) of clip failures, whereas the combination of an MVOA ≤3.0 cm(2) and a TMPG ≥4 mm Hg (n = 16) was associated with a high rate (37.5%) of aborted procedures. Failure rates of ≤10% were observed in all patients with an EROA ≤70.8 mm(2) and either an MVOA >3.0 cm(2) (n = 217) or an MVOA ≤3.0 cm(2) in concert with a TMPG ≤3 mm Hg (n = 39). Multinomial logistic regression identified an EROA >70.8 mm(2) and a TMPG ≥4 mm Hg as independently predictive of clip failure, but an MVOA ≤3.0 cm(2) and a TMPG ≥4 mm Hg as independently predictive of procedure abortion.CONCLUSIONS: In surgical high-risk patients undergoing MitraClip therapy, a TMPG ≥4 mm Hg, an EROA ≥70.8 mm(2), and an MVOA ≤3.0 cm(2) carry an increased risk of procedural failure.

AB - OBJECTIVES: The aim of the study was to assess predictors of acute procedural failure in surgical high-risk patients undergoing MitraClip (Abbott Vascular, Abbott Park, Illinois) therapy.BACKGROUND: MitraClip implantation is a novel percutaneous option to treat significant mitral regurgitation (MR).METHODS: In 300 patients (75 ± 9 years of age, 190 [63%] men), of whom 32 (10.7%) had been unsuccessfully treated (discharge MR grade of >2+), baseline clinical and echocardiographic variables were evaluated by exact logistic regression and classification tree analyses to assess their impact on acute procedural failure. Acute procedural failure was differentiated into aborted procedure (no MitraClip implanted; n = 11) and "clip failure" (inadequate MR reduction despite MitraClip implantation; n = 21).RESULTS: Multivariate logistic regression identified effective regurgitant orifice area (EROA), mitral valve orifice area (MVOA), and mean transmitral pressure gradient (TMPG) as independent predictors of overall acute procedural failure. Classification tree analysis revealed that an EROA >70.8 mm(2) (n = 28) was associated with a high rate (25%) of clip failures, whereas the combination of an MVOA ≤3.0 cm(2) and a TMPG ≥4 mm Hg (n = 16) was associated with a high rate (37.5%) of aborted procedures. Failure rates of ≤10% were observed in all patients with an EROA ≤70.8 mm(2) and either an MVOA >3.0 cm(2) (n = 217) or an MVOA ≤3.0 cm(2) in concert with a TMPG ≤3 mm Hg (n = 39). Multinomial logistic regression identified an EROA >70.8 mm(2) and a TMPG ≥4 mm Hg as independently predictive of clip failure, but an MVOA ≤3.0 cm(2) and a TMPG ≥4 mm Hg as independently predictive of procedure abortion.CONCLUSIONS: In surgical high-risk patients undergoing MitraClip therapy, a TMPG ≥4 mm Hg, an EROA ≥70.8 mm(2), and an MVOA ≤3.0 cm(2) carry an increased risk of procedural failure.

U2 - 10.1016/j.jcin.2013.12.198

DO - 10.1016/j.jcin.2013.12.198

M3 - SCORING: Journal article

C2 - 24630887

VL - 7

SP - 394

EP - 402

JO - JACC-CARDIOVASC INTE

JF - JACC-CARDIOVASC INTE

SN - 1936-8798

IS - 4

ER -