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The MitraClip Asia-Pacific registry: Differences in outcomes between functional and degenerative mitral regurgitation
Edgar Tay1, Nasir Muda2, Jonathan Yap3
1Department of Cardiology, National University Heart Centre, Singapore.
Objectives:
The objective of this study is to describe and compare the use of the MitraClip therapy in mitral regurgitation (MR) patients with degenerative MR (DMR) and functional MR (FMR).
Introduction:
Percutaneous edge-to-edge repair of severe MR using the MitraClip device is approved for use in the USA for high risk DMR while European guidelines include its use in FMR patients as well.
Methods:
The MitraClip in the Asia-Pacific Registry (MARS) is a multicenter retrospective registry, involving eight sites in five Asia-Pacific countries. Clinical and echocardiographic characteristics, procedural outcomes and 1-month outcomes [death and major adverse events (MAE)] were compared between FMR and DMR patients treated with the MitraClip.
Results:
A total of 163 patients were included from 2011 to 2014. The acute procedural success rates for FMR (95.5%, n = 84) and DMR (92%, n = 69) were similar (P = 0.515). 45% of FMR had ≥2 clips inserted compared to 60% of those with DMR (P = 0.064).The 30-day mortality rate for FMR and DMR was similar at 4.5% and 6.7% respectively (P = 0.555). The 30-day MAE rate was 9.2% for FMR and 14.7% for DMR (P = 0.281). Both FMR and DMR patients had significant improvements in the severity of MR and NYHA class after 30 days. There was a significantly greater reduction in left ventricular end-diastolic diameter (P = 0.002) and end systolic diameter (P = 0.017) in DMR than in FMR.
Conclusions:
The MitraClip therapy is a safe and efficacious treatment option for both FMR and DMR. Although, there is a significantly greater reduction in LV volumes in DMR, patients in both groups report clinical benefit with improvement in functional class. © 2015 Wiley Periodicals, Inc.
Insights
MitraClip therapy is safe and effective for both functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR). Both patient groups experienced clinical benefits and improved functional class after treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous edge-to-edge repair using MitraClip is indicated for high-risk degenerative mitral regurgitation (DMR) in the USA.
- European guidelines also support MitraClip use in functional mitral regurgitation (FMR) patients.
Purpose of the Study:
- To describe and compare MitraClip therapy outcomes in DMR versus FMR patients.
- To evaluate procedural success, safety, and 1-month clinical outcomes.
Main Methods:
- Retrospective analysis of the MitraClip in the Asia-Pacific Registry (MARS).
- Comparison of clinical and echocardiographic data between FMR and DMR groups.
- Assessment of procedural success, 30-day mortality, and major adverse events (MAE).
Main Results:
- High acute procedural success rates for both FMR (95.5%) and DMR (92%).
- Similar 30-day mortality (4.5% FMR vs. 6.7% DMR) and MAE rates (9.2% FMR vs. 14.7% DMR).
- Significant improvements in MR severity and NYHA class for both groups; greater reduction in LV volumes for DMR patients.
Conclusions:
- MitraClip therapy is a safe and effective treatment for both FMR and DMR.
- Patients in both FMR and DMR groups achieve clinical benefits and improved functional class.
- DMR patients showed a greater reduction in left ventricular volumes post-MitraClip treatment.
