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Mitral Transcatheter Edge-to-Edge Repair in INTERMACS 3–4 Profile Patients with Severe Mitral Regurgitation

Mitral Transcatheter Edge-to-Edge Repair in INTERMACS 3–4 Profile Patients with Severe Mitral Regurgitation

Authors :
Simone Frea
Stefano Pidello
Filippo Angelini
Paolo Boretto
Pier Paolo Bocchino
Daniele Melis
Giuseppe Giannino
Elena Cavallone
Francesca Giordana
Sara Rettegno
Carol Gravinese
Giulia De Lio
Guglielmo Gallone
Veronica Dusi
Gianluca Alunni
Antonio Montefusco
Fabrizio D'Ascenzo
Massimo Boffini
Claudia Raineri
Mauro Rinaldi
Gaetano Maria De Ferrari
Source :
Journal of Cardiovascular Development and Disease, Vol 11, Iss 11, p 373 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Background: Heart transplantation and left ventricular assist device (LVAD) implementation are effective treatments for advanced heart failure (HF), although their use is limited by organ availability and the high incidence of adverse events. The efficacy of mitral transcatheter edge-to-edge repair (TEER) as a bridge to transplantation or as a destination therapy in advanced HF is still debated. Methods: A total of 63 patients with INTERMACS class 3 or 4 with contraindications for LVAD and severe functional mitral regurgitation (FMR) were evaluated for TEER implantation eligibility. The primary endpoint was a composite of death, urgent heart transplantation and LVAD implantation at 12 months. Results: A total of 36 patients underwent TEER, while 27 patients received optimal medical therapy (MT) alone. In the intervention group, 35 patients (97%) were discharged alive. In the MT group, two in-hospital deaths occurred, two patients underwent urgent heart transplantation, and three patients were discharged on inotropes. At the 12-month follow-up, the incidence of the primary endpoint occurring was lower in the TEER group (25% vs. 70%, HR 0.25, 95% CI 0.11–0.60, p < 0.01) and the tolerance to neurohormonal therapy was higher (53% vs. 30%, p = 0.03). Conclusions: In advanced HF patients with INTERMACS profile 3 or 4 and severe FMR, TEER on top of optimal MT was associated with a lower incidence of death, urgent heart transplantation or LVAD implantation at 12 months compared to optimal MT alone.

Details

Language :
English
ISSN :
23083425
Volume :
11
Issue :
11
Database :
Directory of Open Access Journals
Journal :
Journal of Cardiovascular Development and Disease
Publication Type :
Academic Journal
Accession number :
edsdoj.349ea3badad646778808f438f5bb2070
Document Type :
article
Full Text :
https://doi.org/10.3390/jcdd11110373