PMID- 33107214 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221110 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 7 IP - 6 DP - 2020 Dec TI - MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure. PG - 3891-3900 LID - 10.1002/ehf2.12982 [doi] AB - AIMS: Mitral valve regurgitation (MR) is common in patients with advanced heart failure (HF). Percutaneous mitral valve repair (PMVR) via MitraClip (MC) has emerged as a feasible treatment strategy for these high-risk patients. However, as HF often further progresses, there is a frequent need for left ventricular assist device (LVAD) implantation in these patients. We aimed to investigate whether prior MC implantation affects the subsequent LVAD implantation and outcome. METHODS AND RESULTS: Thirty-seven patients with advanced HF and significant MR who underwent LVAD implantation were retrospectively analysed. Follow-up data were collected at 1 year after LVAD implantation. Primary endpoint was all-cause mortality. Secondary endpoint included peri-operative parameters and clinical development depicted as New York Heart Association (NYHA) class and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Seventeen patients initially received a MC device (MC group), resulting in a significant reduction in MR grade. After MC, NYHA class and INTERMACS level further worsened, leading to subsequent LVAD implantation after a median time of 475 days in the MC group. At LVAD implantation, overall characteristics were comparable with those of the patients undergoing LVAD implantation without prior MC placement (no-MC group). Procedural data revealed a higher incidence of right ventricular (RV) failure needing mechanical RV assistance and a longer need for nitric oxide ventilation in the MC group after LVAD implantation. One-year survival was slightly better in the no-MC group compared with the MC group [41% (n = 7/17) vs. 65% (n = 13/20); P = 0.15], albeit event-free survival was comparable between both groups, MC and no-MC. CONCLUSIONS: LVAD implantation after MC is feasible and safe. However, in patients with advanced HF and severe MR, PMVR may only delay a needed LVAD implantation and thereby lead to poorer peri-operative RV function and impaired outcome. Arguably, these patients might benefit from the timely management of advanced HF by the means of early LVAD implantation or heart transplantation. CI - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. FAU - Kreusser, Michael M AU - Kreusser MM AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. AD - DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany. FAU - Hamed, Sonja AU - Hamed S AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. FAU - Weber, Andreas AU - Weber A AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. FAU - Schmack, Bastian AU - Schmack B AD - Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany. AD - Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany. FAU - Volz, Martin J AU - Volz MJ AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. FAU - Geis, Nicolas A AU - Geis NA AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. FAU - Grossekettler, Leonie AU - Grossekettler L AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. FAU - Pleger, Sven T AU - Pleger ST AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. FAU - Ruhparwar, Arjang AU - Ruhparwar A AD - Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany. AD - Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany. FAU - Katus, Hugo A AU - Katus HA AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. AD - DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany. FAU - Raake, Philip W AU - Raake PW AD - Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. LA - eng PT - Journal Article DEP - 20201026 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM PMC - PMC7754960 OTO - NOTNLM OT - Advanced heart failure OT - Mechanical circulatory support OT - MitraClip OT - Percutaneous mitral valve repair OT - Ventricular assist devices COIS- M.M.K. received research grants from Abbott (Thoratec) and travel grants (for international conferences) from Medtronic (HeartWare). B.S. and A.R. received travel grants (for international conferences) and consultancy fees from Berlin Heart and Abbott. P.W.R. received speaker honoraria from Abbott (Thoratec). The other authors report no conflict of interest regarding the content herein. EDAT- 2020/10/28 06:00 MHDA- 2020/10/28 06:01 PMCR- 2020/10/26 CRDT- 2020/10/27 05:52 PHST- 2020/05/29 00:00 [revised] PHST- 2020/04/16 00:00 [received] PHST- 2020/08/13 00:00 [accepted] PHST- 2020/10/28 06:00 [pubmed] PHST- 2020/10/28 06:01 [medline] PHST- 2020/10/27 05:52 [entrez] PHST- 2020/10/26 00:00 [pmc-release] AID - EHF212982 [pii] AID - 10.1002/ehf2.12982 [doi] PST - ppublish SO - ESC Heart Fail. 2020 Dec;7(6):3891-3900. doi: 10.1002/ehf2.12982. Epub 2020 Oct 26.