| dc.contributor.advisor | Kroemer, Heyo K. Prof. Dr. | |
| dc.contributor.author | Beuthner, Bo Eric | |
| dc.date.accessioned | 2018-03-06T09:45:21Z | |
| dc.date.available | 2018-03-22T23:50:11Z | |
| dc.date.issued | 2018-03-06 | |
| dc.identifier.uri | http://hdl.handle.net/11858/00-1735-0000-002E-E378-E | |
| dc.identifier.uri | http://dx.doi.org/10.53846/goediss-6760 | |
| dc.identifier.uri | http://dx.doi.org/10.53846/goediss-6760 | |
| dc.language.iso | deu | de |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject.ddc | 610 | de |
| dc.title | Langzeitverlauf einer sekundären Rechtsherzbelastung nach perkutaner Mitralklappenreparatur mittels MitraClip | de |
| dc.type | doctoralThesis | de |
| dc.title.translated | Impact of MitraClip Implantation on Right Heart Function | de |
| dc.contributor.referee | Puls, Miriam PD Dr. | |
| dc.date.examination | 2018-03-13 | |
| dc.description.abstracteng | Background: The MitraClip procedure is a catheter-based method for percutaneous repair of mitral regurgitation in patients with high operative risk. Right heart failure and pulmonary hypertension are known predictors of increased mortality after mitral valve repair. Our aim was to identify the impact of MitraClip implantation on the right heart. Furthermore, we sought to analyze how changes in the right heart impacted the survival of patients.
Methods: We conducted a prospective multi-center observatory trial between 2009 and 2011. 70 patients were enrolled. Inclusion criteria were clinical signs of right heart failure as well as echocardiographic signs of pulmonary hypertension (PAP syst>50mmHg) and tricuspid regurgitation >II°. Echocardiography was carried out before intervention, at the point of discharge and 12±2 months after intervention. A six-minute-walk-test and a Minnesota Living with Heart Failure Questionnaire werde carried out before intervention and 6±2 months after. In the fall of 2013 all patients were contacted to identify events of death. Continuous variables were analyzed using Wilcoxon matched pairs test. Kapan-Meier-curves and logrank tests were used for survival analysis.
Results: Mean age of our patient cohort was 73±9 years, 66% of patients were male. Secondary mitral regurgitation was dominant (71%). Patients suffered from severe congestive heart failure (NYHA III or higher: 94%) and had a very high operative risk (mean log. EuroScore I 30±12%).
We were able to observe a significant reduction of systolic pulmonary arterial pressure (60,85 vs. 54,0 mmHg; p=0,04) at discharge. TAPSE increased significantly at discharge (16,0 vs. 20,0 mm, p=0,002). The maximum velocity of tricuspid regurgitation also decreased significantly at discharge (3,51 vs. 3,16 m/s, p=0,001). All results remained stable 12 months after intervention without reaching new statistical significance compared to the results at discharge.
Vena contracta and RVOT showed a significant reduction 12 months after intervention (0,74 vs. 0,77mm, p=0,01 respectively 3,30 vs. 3,52cm, p=0,01).
17 patients showed a normalization of TAPSE 12 months after intervention. These patients had a significant better survival than patients whose TAPSE decreased or remained unchanged 12 months after MitraClip implantation (p=0,03).
Conclusion: MitraClip implantation leads to acute hemodynamic improvements in patients with pulmonary hypertension and tricuspid regurgitation. Patients whose TAPSE normalizes within one year after percutaneous mitral valve repair show a significant better survival. Therefore, right heart failure should not be used as a criterion against MitraClip implantation as long as a comparable survival benefit has not been shown for medical treatment. Further sudies are needed to identify factors that predict right heart recovery after MitraClip implantation. | de |
| dc.contributor.coReferee | Tirilomis, Theodor Prof. Dr. | |
| dc.contributor.thirdReferee | Sigler, Matthias Prof. Dr. | |
| dc.subject.eng | MitraClip | de |
| dc.identifier.urn | urn:nbn:de:gbv:7-11858/00-1735-0000-002E-E378-E-9 | |
| dc.affiliation.institute | Medizinische Fakultät | de |
| dc.subject.gokfull | Kardiologie (PPN619875755) | de |
| dc.description.embargoed | 2018-03-20 | |
| dc.identifier.ppn | 1015337988 | |