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

Tichelbäcker, Tobias

dc.contributor.advisor	Schillinger, Wolfgang Prof. Dr.
dc.contributor.author	Tichelbäcker, Tobias
dc.date.accessioned	2014-09-18T06:26:18Z
dc.date.available	2014-09-30T22:50:05Z
dc.date.issued	2014-09-18
dc.identifier.uri	http://hdl.handle.net/11858/00-1735-0000-0022-5F78-A
dc.identifier.uri	http://dx.doi.org/10.53846/goediss-4691
dc.language.iso	deu	de
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/3.0/
dc.subject.ddc	610	de
dc.title	Prädiktoren für die Prognose nach perkutaner Mitralklappenreparatur mit dem MitraClip®-System	de
dc.type	doctoralThesis	de
dc.title.translated	Predictors of outcome after percutaneous edge-to-edge mitral valve repair	de
dc.contributor.referee	Tirilomis, Theodor PD Dr.
dc.date.examination	2014-09-23
dc.description.abstracteng	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.	de
dc.contributor.coReferee	Sigler, Matthias PD Dr.
dc.subject.ger	MitraClip®	de
dc.subject.ger	Perkutane Mitralklappenreparatur	de
dc.subject.ger	Mitralklappeninsuffizienz	de
dc.subject.ger	Herzinsuffizienz	de
dc.subject.eng	MitraClip®	de
dc.subject.eng	percutanous mitral valve repair	de
dc.subject.eng	mitral regurgitation	de
dc.subject.eng	heart failure	de
dc.identifier.urn	urn:nbn:de:gbv:7-11858/00-1735-0000-0022-5F78-A-5
dc.affiliation.institute	Medizinische Fakultät	de
dc.subject.gokfull	Medizin (PPN619874732)	de
dc.description.embargoed	2014-09-30
dc.identifier.ppn	797010955

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Human- und Zahnmedizin [2872]

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