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Published on: October 16, 2021
Percutaneous edge-to-edge mitral valve repair in high-surgical-risk patients: do we hit the target?
Ben J L Van den Branden1, Martin J Swaans, Martijn C Post
1Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. b.van.den.branden@antoniusziekenhuis.nl
Objectives:
This study sought to assess the feasibility and safety of percutaneous edge-to-edge mitral valve (MV) repair in patients with an unacceptably high operative risk.
Background:
MV repair for mitral regurgitation (MR) can be accomplished by use of a clip that approximates the free edges of the mitral leaflets.
Methods:
All patients were declined for surgery because of a high logistic EuroSCORE (>20%) or the presence of other specific surgical risk factors. Transthoracic echocardiography was performed before and 6 months after the procedure. Differences in New York Heart Association (NYHA) functional class, quality of life (QoL) using the Minnesota questionnaire, and 6-min walk test (6-MWT) distances were reported.
Results:
Fifty-five procedures were performed in 52 patients (69.2% male, age 73.2 ± 10.1 years, logistic EuroSCORE 27.1 ± 17.0%). In 3 patients, partial clip detachment occurred; a second clip was placed successfully. One patient experienced cardiac tamponade. Two patients developed inguinal bleeding, of whom 1 needed surgery. Six patients (11.5%) died during 6-month follow-up (5 patients as a result of progressive heart failure and 1 noncardiac death). The MR grade before repair was ≥3 in 100%; after 6 months, a reduction in MR grade to ≤2 was present in 79% of the patients. Left ventricular (LV) end-diastolic diameter, LV ejection fraction, and systolic pulmonary artery pressure improved significantly. Accompanied improvements in NYHA functional class, QoL index, 6-MWT distances, and log N-terminal pro-B-type natriuretic peptide were observed.
Conclusions:
In a high-risk population, MR reduction can be achieved by percutaneous edge-to-edge valve repair, resulting in LV remodeling with improvement of functional capacity after 6 months.
Insights
Percutaneous edge-to-edge mitral valve repair is a feasible and safe option for high-risk patients with mitral regurgitation. This minimally invasive procedure effectively reduces mitral regurgitation and improves heart function and quality of life within six months.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology
Background:
- Mitral regurgitation (MR) poses a significant clinical challenge, often requiring intervention.
- Traditional mitral valve (MV) repair via surgery carries substantial risks for many patients.
- Percutaneous edge-to-edge repair offers an alternative approach using clips to approximate mitral leaflets.
Purpose of the Study:
- To evaluate the feasibility and safety of percutaneous edge-to-edge mitral valve repair.
- To assess the efficacy of this procedure in patients deemed inoperable due to high surgical risk.
- To determine the impact on patient functional capacity and quality of life.
Main Methods:
- Fifty-five percutaneous edge-to-edge MV repair procedures were performed in high-risk patients (logistic EuroSCORE >20%).
- Transthoracic echocardiography was utilized for pre- and post-procedure assessments at 6 months.
- Evaluated outcomes included New York Heart Association (NYHA) functional class, quality of life (QoL), and 6-minute walk test (6-MWT) distance.
Main Results:
- Successful MR reduction to grade ≤2 was achieved in 79% of patients.
- Significant improvements were observed in left ventricular (LV) dimensions, LV ejection fraction, and pulmonary artery pressure.
- Patients demonstrated enhanced NYHA class, QoL, 6-MWT, and reduced N-terminal pro-B-type natriuretic peptide levels.
Conclusions:
- Percutaneous edge-to-edge MV repair is a viable option for high-risk patients with significant MR.
- The procedure leads to effective MR reduction and favorable left ventricular remodeling.
- Significant functional capacity and quality of life improvements are evident at 6-month follow-up.
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