Can elderly patients with severe mitral regurgitation benefit from trans-catheter mitral valve repair?

• Main Authors: Ching-Wei Lee, 李慶威
• Other Authors: Kuo-Piao Chung
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/se2spx

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 106 === Background: Age is a traditional risk factor for open-heart surgery. The efficacy and safety of transcatheter edge-to-edge mitral valve repair, using MitraClip, has been demonstrated in patients with severe mitral regurgitation (MR). Since octogenarians or even older patients are usually deferred to receive open-heart surgery, the main interest of this study is to elucidate the procedural safety and long term clinical impact of MitraClip in elderly patients. Methods: Patients with symptomatic severe MR were evaluated by the heart team. For those with high or prohibitive surgical risks, transcatheter mitral valve repair was performed in hybrid operation room. Transthoracic echocardiography (TTE), blood tests, and six-minute walk test (6MWT) were performed before, 1-month, 6-month, and 1 year after surgery. Results: A total of 46 consecutive patients receiving MitraClip procedure were enrolled. 19 patients (84.2 ± 4.0 years, 63% male) were over 80 year-old and 27 (73.4 ± 11.1 years, 81% male) were younger than 80. Except for poorer left ventricular ejection fraction (LVEF) in the younger group, there was no significant difference in baseline characteristics, comorbidities, and surgical risk profiles. The procedural success rate was similar (aged ≥80 years and <80 years, 95% vs. 93%, p = 1.00). There was no peri-procedural death, myocardial infarction, stroke or any events requiring emergent cardiac surgery in both groups. Compared with baseline, the significant reduction in MR severity was achieved after the procedure and sustained for 1 year. At the same time, all the patients benefited from significant improvement in New York Heart Association (NYHA) functional class after the procedure. The NT-proBNP level continuously decreased since 1st month after the index procedure. The 6MWT increased from 259 ± 114 meters to 313 ± 107 (p = 0.02) at 1 month, and up to 319 ± 92 (p = 0.03) at 1 year. During follow-up period, 6 patients experienced death whereas 3 are cardiovascular mortality. The overall 1-year survival rate was 86% (80% in aged ≥80 years and 88% in those < 80 years, p = 0.590). There was also no difference in 1-year free from all-cause mortality or heart failure admission rate between two groups (70% in aged ≥80 years and 78% in those < 80 years, p = 0.738). By univariate analysis, pre-procedural 6MWT was a predictor for all-cause mortality (OR 0.99, 95% CI: 0.982-0.999, p = 0.026) after the MitraClip procedure but not age (OR 1.12, 95% CI: 0.975-1.299, p = 0.108) Conclusions: Trans-catheter edge-to-edge mitral valve repairs are safe and have positive clinical impact in subjects with severe MR, even in advanced age. Octogenarians can also benefit from MitraClip procedure in respect of heart failure symptoms and functional capacities.