Relation of Residual Mitral Regurgitation Despite Elevated Mitral Gradients to Risk of Heart Failure Hospitalization after MitraClip Repair

5 years ago

Relation of Residual Mitral Regurgitation Despite Elevated Mitral Gradients to Risk of Heart Failure Hospitalization after MitraClip Repair

Achieving minimal residual mitral regurgitation (MR) after percutaneous MitraClip repair is limited by iatrogenic mitral stenosis. It is unknown whether allowing moderately-elevated post-procedural mean mitral gradients (MMG) to achieve < moderate residual MR is preferable to moderate residual regurgitation. Patients with less-than-moderate residual MR but a MMG≥5 mmHg (Group 1) were compared with patients with moderate residual MR (Group 2). The primary endpoint was heart failure hospitalization. Secondary endpoints included mortality, subsequent mitral valve (MV) surgery, and MR at 1-yr. 78 patients were included in the study. Group 1 included 48 patients (median MMG 6 IQR 5-6 mmHg. Group 2 included 30 patients (median MMG 3.5 IQR 2-5 mmHg). Age, baseline MR severity, and type of MR were not different between groups. Freedom from heart failure hospitalization at 1-yr was 91.2±4.2% in Group 1 versus 70.8±8.7% in Group 2 (p=0.021). Achieved differences in MR reduction between groups persisted at 1-yr (p=0.007). Survival was not different (p=0.402), and subsequent MV surgery occurred in 4/48 (8%) and 4/30 (13%) p=0.476. By multivariate Cox regression analysis, less-than-moderate residual MR despite moderately elevated mitral gradients was associated with a hazards ratio of 0.21 (95% CI 0.04-0.96) for subsequent heart failure hospitalization (p=0.044). In conclusion, patients with less-than-moderate residual MR in-spite-of a MMG≥5 had a 79% reduction in hazard for subsequent heart failure hospitalization as compared with patients with moderate residual MR.

Publisher URL: www.sciencedirect.com/science

DOI: S000291491731192X