Five-year clinical outcomes after percutaneous edge-to-edge mitral valve repair: Insights from the multicenter GRASP-IT registry - 15/11/19
, Carmelo Grasso, MD b, Davide Capodanno, MD, PhD b, Antonio Popolo Rubbio, MD b, Salvatore Scandura, MD b, Cristina Giannini, MD, PhD c, Francesca Fiorelli, MD c, Claudia Fiorina, MD a, Luca Branca, MD a, Nedy Brambilla, MD d, Francesco Bedogni, MD d, Anna Sonia Petronio, MD c, Salvatore Curello, MD a, Corrado Tamburino, MD, PhD bBackground |
Limited evidence is available on 5-year clinical outcomes after percutaneous edge-to-edge mitral valve repair.
Methods |
The Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation in ITaly (GRASP-IT) is a multicenter registry including 304 consecutive patients undergoing Mitraclip between October 2008 and October 2013 at 4 Italian centers. Primary end point (all-cause mortality) and secondary end point (all-cause mortality or heart failure [HF] hospitalization) were evaluated up to 5 years and between 1 and 5 years.
Results |
Cumulative incidence of the primary and secondary end points at 1, 2, 3, 4, and 5 years were 15.1%, 26.4%, 35.5%, 42.1%, and 47.3% and 29.1%, 41.7%, 49.8%, 56%, and 62.3%, respectively. Landmark analysis between 1 and 5 years showed an incidence of primary and secondary end point of 37.9% and 46.8%, respectively. Five-year event rates were significantly higher in patients with functional ischemic mitral regurgitation (MR) compared to other etiologies. MR recurrence and left ventricular ejection fraction <30% were associated with an increased risk of both primary and secondary end points. EuroSCORE II >5% was associated with an increased risk of 5-year mortality. Ischemic etiology of MR, baseline serum creatinine >1.5 mg/dL, chronic obstructive pulmonary disease, and previous HF hospitalizations were independent predictors of 5-year secondary end point.
Conclusions |
At 5-year follow-up after Mitraclip, nearly half of patients died and almost two thirds died or were admitted for HF. MR recurrence, ischemic etiology, high comorbidity burden (ie, EuroSCORE II >5%, chronic obstructive pulmonary disease), and advanced cardiomyopathy (ie, left ventricular ejection fraction <30%, prior HF admission, creatinine >1.5 mg/dL) significantly increase the relative risk of 5-year clinical events.
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| Conflicts: Francesco Bedogni and Carmelo Grasso are proctor physicians for Abbott Vascular. Davide Capodanno received consulting honoraria from Abbott Vascular. Corrado Tamburino received speaker's honoraria from Abbott Vascular. The other authors have not conflicts of interest to report. |
Vol 217
P. 32-41 - novembre 2019 Retour au numéro
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