3 years ago

Comparison of Outcome after Percutaneous Mitral Valve Repair with the MitraClip in Patients with Versus Without Atrial Fibrillation

Percutaneous mitral valve repair with the MitraClip is an established treatment for patients with mitral regurgitation (MR) who are inoperable or at high risk for surgery. Atrial Fibrillation (AF) frequently coincides with MR, but only scarce data of the influence of AF on outcome after MitraClip is available. The aim of the current study was to compare the clinical outcome after MitraClip treatment in patients with versus without atrial fibrillation. Between January 2009 and January 2016, all consecutive patients treated with a MitraClip in 5 Dutch centers were included. Outcome measures were survival, symptoms, mitral regurgitation grade and stroke incidence. In total, 618 patients were treated with a MitraClip. Patients with AF were older, had higher N-terminal B-type natriuretic peptide levels, more tricuspid regurgitation, less often coronary artery disease and a better left ventricular function. Survival of patients treated with the MitraClip was similar for patients with AF(82%) and non-AF(85%) after 1 year(p=0.30), but significantly different after 5 year follow-up (AF:34%;non-AF:47%; p=0.006). After 1 month, 64% of the patients with AF were in New York Heart Association (NYHA) class I or II, in contrast to 77% of the patients without AF (p=0.001). The stroke incidence appeared not to be significantly different (AF:1.8%;non-AF:1.0%; p=0.40). In conclusion, patients with AF had similar 1-year survival, MR reduction and stroke incidence compared to non-AF patients. However, MitraClip patients with AF had reduced long-term survival and remained more symptomatic compared to those without AF.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313929

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