Structural
Clinical Research
MitraClip Therapy in Surgical High-Risk Patients: Identification of Echocardiographic Variables Affecting Acute Procedural Outcome

https://doi.org/10.1016/j.jcin.2013.12.198Get rights and content
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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 mm2 (n = 28) was associated with a high rate (25%) of clip failures, whereas the combination of an MVOA ≤3.0 cm2 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 mm2 and either an MVOA >3.0 cm2 (n = 217) or an MVOA ≤3.0 cm2 in concert with a TMPG ≤3 mm Hg (n = 39). Multinomial logistic regression identified an EROA >70.8 mm2 and a TMPG ≥4 mm Hg as independently predictive of clip failure, but an MVOA ≤3.0 cm2 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 mm2, and an MVOA ≤3.0 cm2 carry an increased risk of procedural failure.

Key Words

MitraClip
mitral regurgitation
percutaneous mitral valve repair

Abbreviations and Acronyms

CI
confidence interval
DMR
mitral regurgitation of degenerative/mixed origin
EROA
effective regurgitant orifice area
FMR
mitral regurgitation of functional origin
IQR
interquartile range
MR
mitral regurgitation
MVOA
mitral valve orifice area
OR
odds ratio
TMPG
mean transmitral pressure gradient

Cited by (0)

Dr. Rudolph has received an unrestricted research grant and lecture fees from Abbott Vascular. Dr. Baldus has received research grants and honoraria from Abbott. Dr. Blankenberg has received research grants from Boehringer Ingelheim, Bayer, Abbott Diagnostics, Siemens, and Thermo Fisher; is an advisory board member for Novartis, Boehringer Ingelheim, Bayer, Thermo Fisher, and Roche; and has received lecture fees from AstraZeneca, Bayer, Boehringer Ingelheim, Siemens, Abbott Diagnostics, Abbott, Medtronic, Pfizer, Roche, Siemens Diagnostics, and Thermo Fisher. Dr. Goldman has received a research grant from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Bakhus and Rudolph are currently affiliated with Uniklinik Köln, Herzzentrum, Klinik III für Innere Medizin, Cologne, Germany.