Prädiktoren für die Prognose nach perkutaner Mitralklappenreparatur mit dem MitraClip®-System

Predictors of outcome after percutaneous edge-to-edge mitral valve repair

by Tobias Tichelbäcker
Doctoral thesis
Date of Examination:2014-09-23
Date of issue:2014-09-18
Advisor:Prof. Dr. Wolfgang Schillinger
Referee:PD Dr. Theodor Tirilomis
Referee:PD Dr. Matthias Sigler
Persistent Address: http://dx.doi.org/10.53846/goediss-4691

 

 

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Abstract

English

Background: Predictors for prognosis after percutaneous mitral valve Repair with MitraClip® are widely unexplored. Methods: We analyzed our patients cohort of 150 consecutive high risk-patients, first patient provided with MitraClip® in April 2009, with Kaplan-Meier-Analysis to find out the impact of possible predictors on mortality and hospitalization because of Heart Failure. After univariate analysis significant predictors have been tested in a cox proportional hazard model for multivariate significance. Results: Our patients had an average age of 74±9 years and a high risk for open heart surgery (log. EuroSCORE I 29±18 %, STS-Score 10.5±8,7%). 66% of the patients had a functional mitral regurgitation (MR). An acute procedural success (defined as MR≤2 at discharge) was reached in 85% of the patients. Survival rate after 30 days was 96%, after one year 79% and after two years 63%. Median Follow-Up time was 274 days. Patients report less symptoms after 12 months (MLHFQ -19.5 points; p<0.001 and 6-MWT + 67.5 meters; p=0.02) Echocardiographic parameters showed a significant reduction of the left ventricular enddiastolic diameter (p=0.013) and enddiastolic volume (p<0.0001). In the multivariate analysis only failure of acute procedural success (HR 2.73, p=0.005), NYHA stadium IV before clip implantation (HR 2.12, p=0.02) and STS-Score ≥12 (HR 2.07, p<0.0001) could be proofed as significant predictors of mortality. Predictor of hospitalization due to heart failure after multivariate analysis was failure of procedural success (HR 2.69, p=0.004). Conclusion: Our data implicate that patient selection should be performed carefully by specialized heart teams to guarantee acute procedural success. Patients with failure of acute procedural success had significant larger ventricles, mitral regurgitation grade IV, pulmonal hypertonus and did not meet the EVEREST-II-criteria. Failure of acute procedural success was the most important predictor concerning long term outcome and must be avoided in any case. Here for the focus on rigorous screening is to emphasize especially in centres without larger experience.
Keywords: MitraClip®; percutanous mitral valve repair; mitral regurgitation; heart failure
Schlagwörter: MitraClip®; Perkutane Mitralklappenreparatur; Mitralklappeninsuffizienz; Herzinsuffizienz
 
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