Interactive cardiovascular and thoracic surgery · 2016
Minimally invasive mitral valve repair for functional mitral regurgitation in severe heart failure: MitraClip versus minimally invasive surgical approach.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Ondrus Tomas, Bartunek Jozef, Vanderheyden Marc, Stockman Bernard, Kotrc Martin, Van Praet Frank, Van Camp Guy, Lecomte Patrick, Mo Yujing, Penicka Martin
Аннотация
OBJECTIVES: To compare the outcomes of MitraClip versus minimally invasive surgical mitral valve repair in high-risk patients with significant functional mitral regurgitation (FMR) and severe heart failure in a centre having pilot versus extensive experience with the MitraClip and the minimally invasive surgical approach, respectively.
METHODS: The MitraClip group consisted of 24 high-surgical-risk patients [age 75 ± 9 years, 75% males, NYHA III/IV 88%, left ventricular (LV) ejection fraction 31 ± 9%, EuroSCORE II 18 ± 14%], while the surgical group consisted of 48 patients matched for age, NYHA class and LV ejection fraction.
RESULTS: Patients undergoing MitraClip versus those undergoing surgical repair showed higher prevalence of ischaemic LV dysfunction and larger LV end-diastolic diameter (both P < 0.05). Both the MitraClip and the surgical repair groups had similar 30-day mortality rates (4 vs 13%, P = 0.41) and prevalence of serious adverse events (25 vs 38%, P = 0.43). The median follow-up was 1028 days (IQR: 272-1564 days) in the MitraClip group and 890 days (IQR: 436-1381 days) in the surgical group (P = 0.95). Total all-cause mortality (54 vs 60%, log-rank P = 0.64) and rates of rehospitalizations for heart failure (42 vs 29%, log-rank P = 0.68) did not differ significantly between groups. Both techniques were associated with significant decrease in NYHA class and severity of FMR (P < 0.001 for all) and with a similar degree of stabilization of LV remodelling (P = NS).
CONCLUSION: Despite the significant baseline differences in accumulated expertise and risk profile between the surgical and the MitraClip groups, both minimally invasive techniques were associated with similar 30-day and long-term outcomes.
METHODS: The MitraClip group consisted of 24 high-surgical-risk patients [age 75 ± 9 years, 75% males, NYHA III/IV 88%, left ventricular (LV) ejection fraction 31 ± 9%, EuroSCORE II 18 ± 14%], while the surgical group consisted of 48 patients matched for age, NYHA class and LV ejection fraction.
RESULTS: Patients undergoing MitraClip versus those undergoing surgical repair showed higher prevalence of ischaemic LV dysfunction and larger LV end-diastolic diameter (both P < 0.05). Both the MitraClip and the surgical repair groups had similar 30-day mortality rates (4 vs 13%, P = 0.41) and prevalence of serious adverse events (25 vs 38%, P = 0.43). The median follow-up was 1028 days (IQR: 272-1564 days) in the MitraClip group and 890 days (IQR: 436-1381 days) in the surgical group (P = 0.95). Total all-cause mortality (54 vs 60%, log-rank P = 0.64) and rates of rehospitalizations for heart failure (42 vs 29%, log-rank P = 0.68) did not differ significantly between groups. Both techniques were associated with significant decrease in NYHA class and severity of FMR (P < 0.001 for all) and with a similar degree of stabilization of LV remodelling (P = NS).
CONCLUSION: Despite the significant baseline differences in accumulated expertise and risk profile between the surgical and the MitraClip groups, both minimally invasive techniques were associated with similar 30-day and long-term outcomes.