PMID- 23401496
OWN - NLM
STAT- MEDLINE
DCOM- 20140509
LR  - 20130815
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 44
IP  - 3
DP  - 2013 Sep
TI  - Surgical or percutaneous mitral valve repair for secondary mitral regurgitation: 
      comparison of patient characteristics and clinical outcomes.
PG  - 490-6; discussion 496
LID - 10.1093/ejcts/ezt036 [doi]
AB  - OBJECTIVES: Corrective surgery for secondary mitral regurgitation (MR) by 
      restrictive annuloplasty has proven beneficial in that it improves New York Heart 
      Association (NYHA) functional class and induces reverse left ventricular 
      remodelling. However, proof of a survival benefit for these patients is still 
      pending. Percutaneous techniques of mitral valve repair (MVR) have become a 
      viable treatment alternative for selected high-risk patients with severe 
      secondary MR. METHODS: We retrospectively analysed our prospective hospital 
      database of patients with severe secondary MR undergoing either surgical MVR or 
      percutaneous treatment using the MitraClip device. Patient characteristics and 
      6-month clinical and effectiveness outcomes are reported. RESULTS: From March 
      2002 through June 2010, 76 patients with secondary MR underwent isolated surgical 
      MVR, while 95 were treated using the MitraClip device at our centre. Patients 
      undergoing MitraClip treatment were significantly older (mean 72.8 +/- 8.2 vs 64.5 
      +/- 11.4 years, P < 0.001), had a lower left ventricular ejection fraction (mean 
      36.2 +/- 12.5 vs 42.1 +/- 16.2%, P = 0.014) and were generally more high risk, with a 
      significantly higher mean logistic EuroSCORE I compared with surgical candidates 
      (33.7 +/- 18.7 vs 10.1 +/- 8.7%, P < 0.001). Procedural success was 98.7 (75 of 76) 
      for MVR and 95.8% (91 of 95) for MitraClip treatment (P = 0.383). Thirty-day 
      mortality was 4.2 (4 of 95) and 2.6% (2 of 76; P = 0.557), and the mean grade of 
      residual MR was 1.4 +/- 0.8 and 0.2 +/- 0.4 (P < 0.001) after MitraClip treatment and 
      surgical MVR, respectively. Six-month survival rates after adjustment for 
      baseline differences were not significantly different in the respective groups (P 
      = 0.642). CONCLUSIONS: In our experience, characteristics and risk factors of 
      patients with severe secondary MR undergoing surgery differ significantly from 
      those considered for percutaneous therapy. Surgery was more effective compared 
      with MitraClip in reducing MR. However, a large proportion of patients benefits 
      from percutaneous intervention with sustained MR Grade <2+ and improvement in 
      NYHA functional class at 6 months. MitraClip therapy seems to be an adequate 
      alternative to surgery, especially for elderly patients with reduced left 
      ventricular function and relevant comorbidities. Assessment, treatment and 
      postprocedural care of patients by an interdisciplinary team are of paramount 
      importance for clinical success.
FAU - Conradi, Lenard
AU  - Conradi L
AD  - University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, 
      Hamburg, Germany. lconradi@uke.de
FAU - Treede, Hendrik
AU  - Treede H
FAU - Rudolph, Volker
AU  - Rudolph V
FAU - Graumuller, Paul
AU  - Graumuller P
FAU - Lubos, Edith
AU  - Lubos E
FAU - Baldus, Stephan
AU  - Baldus S
FAU - Blankenberg, Stefan
AU  - Blankenberg S
FAU - Reichenspurner, Hermann
AU  - Reichenspurner H
LA  - eng
PT  - Journal Article
DEP - 20130210
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Echocardiography
MH  - Female
MH  - Heart Valve Prosthesis Implantation/adverse effects/*methods
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/*surgery
MH  - Postoperative Complications/etiology
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Functional mitral regurgitation
OT  - MitraClip
OT  - Mitral valve repair
OT  - Percutaneous
EDAT- 2013/02/13 06:00
MHDA- 2014/05/10 06:00
CRDT- 2013/02/13 06:00
PHST- 2013/02/13 06:00 [entrez]
PHST- 2013/02/13 06:00 [pubmed]
PHST- 2014/05/10 06:00 [medline]
AID - ezt036 [pii]
AID - 10.1093/ejcts/ezt036 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2013 Sep;44(3):490-6; discussion 496. doi: 
      10.1093/ejcts/ezt036. Epub 2013 Feb 10.