Percutaneous mitral valve repair: The last chance for symptoms improvement in advanced refractory chronic heart failure?

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• 作者：Alessandra Berardini^a ; ¹ ; Elena Biagini^a ; ¹ ; Francesco Saia^a ; ¹ ; Davide Stolfo^b ; ¹ ; Mario Previtali^c ; ¹ ; Francesco Grigioni^a ; ¹ ; Bruno Pinamonti^b ; ¹ ; Gabriele Crimi^c ; ¹ ; Alessandro Salvi^b ; ¹ ; Maurizio Ferrario^c ; ¹ ; Antonio De Luca^b ; ¹ ; Fabrizio Gazzoli^d ; ¹ ; Maria Letizia Bacchi Reggiani^a ; ¹ ; Claudia Raineri^c ; ¹ ; Gianfranco Sinagra^b ; ¹ ; Claudio Rapezzi^a ; ¹ ; ^{claudio.rapezzi@unibo.it}
• 关键词：Mitral regurgitation ; Heart failure ; Percutaneous mitral valve repair ; Remodeling
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：191-197
• 全文大小：506 K
• 卷排序：228

文摘

The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear.MethodsSeventy-five consecutive patients with FMR grade ≥ 3 + and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month.ResultsMean age was 67 ± 11 years, logistic EuroSCORE = 23 ± 18%, left ventricle ejection fraction (LVEF) 30 ± 9%. In 6 patients (8%) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3% (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84%) were discharged with MR ≤ 2 +. At 6-month, 4 patients died (5%), 80% had MR ≤ 2 + and 75% were in New York Heart Association class ≤ II. Median pro-BNP decreased from 4395 pg/ml to 2594 pg/ml (p = 0.04). There were no significant changes in LV end-diastolic volume (222 ± 75 ml vs. 217 ± 79, p = 0.19), end-systolic volume (LVESV, 154 ± 66 ml vs. 156 ± 69, p = 0.54) and LVEF (30 ± 9% vs. 30 ± 12%, p = 0.86). Significant reverse remodeling (reduction of LVESV ≥ 10%) was observed in 25%, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6 months before PMVR were reduced from 1.1 ± 0.8 to 0.3 ± 0.6 (p < 0.001).ConclusionsIn extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6 months, despite the lack of LV reverse remodeling.