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Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair.

Publication ,  Journal Article
Lim, DS; Reynolds, MR; Feldman, T; Kar, S; Herrmann, HC; Wang, A; Whitlow, PL; Gray, WA; Grayburn, P; Mack, MJ; Glower, DD
Published in: J Am Coll Cardiol
July 15, 2014

BACKGROUND: Surgical mitral valve repair (SMVR) remains the gold standard for severe degenerative mitral regurgitation (DMR). However, the results with transcatheter mitral valve repair (TMVR) in prohibitive-risk DMR patients have not been previously reported. OBJECTIVES: This study aimed to evaluate treatment of mitral regurgitation (MR) in patients with severe DMR at prohibitive surgical risk undergoing TMVR. METHODS: A prohibitive-risk DMR cohort was identified by a multidisciplinary heart team that retrospectively evaluated high-risk DMR patients enrolled in the EVEREST (Endovascular Valve Edge-to-Edge Repair Study) II studies. RESULTS: A total of 141 high-risk DMR patients were consecutively enrolled; 127 of these patients were retrospectively identified as meeting the definition of prohibitive risk and had 1-year follow-up (median: 1.47 years) available. Patients were elderly (mean age: 82.4 years), severely symptomatic (87% New York Heart Association class III/IV), and at prohibitive surgical risk (STS score: 13.2 ± 7.3%). TMVR (MitraClip) was successfully performed in 95.3%; hospital stay was 2.9 ± 3.1 days. Major adverse events at 30 days included death in 6.3%, myocardial infarction in 0.8%, and stroke in 2.4%. Through 1 year, there were a total of 30 deaths (23.6%), with no survival difference between patients discharged with MR ≤1+ or MR 2+. At 1 year, the majority of surviving patients (82.9%) remained MR ≤2+ at 1 year, and 86.9% were in New York Heart Association functional class I or II. Left ventricular end-diastolic volume decreased (from 125.1 ± 40.1 ml to 108.5 ± 37.9 ml; p < 0.0001 [n = 69 survivors with paired data]). SF-36 quality-of-life scores improved and hospitalizations for heart failure were reduced in patients whose MR was reduced. CONCLUSIONS: TMVR in prohibitive surgical risk patients is associated with safety and good clinical outcomes, including decreases in rehospitalization, functional improvements, and favorable ventricular remodeling, at 1 year. (Real World Expanded Multi-center Study of the MitraClip System [REALISM]; NCT01931956).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 15, 2014

Volume

64

Issue

2

Start / End Page

182 / 192

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Recovery of Function
  • Quality of Life
  • Prospective Studies
  • Prognosis
 

Citation

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ICMJE
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Lim, D. S., Reynolds, M. R., Feldman, T., Kar, S., Herrmann, H. C., Wang, A., … Glower, D. D. (2014). Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol, 64(2), 182–192. https://doi.org/10.1016/j.jacc.2013.10.021
Lim, D Scott, Matthew R. Reynolds, Ted Feldman, Saibal Kar, Howard C. Herrmann, Andrew Wang, Patrick L. Whitlow, et al. “Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair.J Am Coll Cardiol 64, no. 2 (July 15, 2014): 182–92. https://doi.org/10.1016/j.jacc.2013.10.021.
Lim DS, Reynolds MR, Feldman T, Kar S, Herrmann HC, Wang A, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014 Jul 15;64(2):182–92.
Lim, D. Scott, et al. “Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair.J Am Coll Cardiol, vol. 64, no. 2, July 2014, pp. 182–92. Pubmed, doi:10.1016/j.jacc.2013.10.021.
Lim DS, Reynolds MR, Feldman T, Kar S, Herrmann HC, Wang A, Whitlow PL, Gray WA, Grayburn P, Mack MJ, Glower DD. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014 Jul 15;64(2):182–192.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 15, 2014

Volume

64

Issue

2

Start / End Page

182 / 192

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Recovery of Function
  • Quality of Life
  • Prospective Studies
  • Prognosis