JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
VOL. 69, NO. 23, 2017
ª 2017 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER
Letters percutaneous mitral valve repair procedures. The use
Percutaneous Mitral Valve Repair
of >2 devices changed over time, with 29% in the first one-third and 54% in the last one-third of the patients. MR was assessed as grade #2 in 80% (n ¼ 468)
Refining Selection Criteria
of patients who underwent transthoracic echocardiography at discharge (n ¼ 585). In-hospital mortality
Functional and degenerative mitral regurgitation
was 1.9% (n ¼ 12). Cumulative survival was 97% after
(MR) is common among the elderly with a prevalence
30 days, 84% after 1 year, and 40% after 5 years. One
of approximately 7% (1). Many are denied for surgery
year after MitraClip implantation, 69% of the patients
because of high risks, but suitable patients may
were in NYHA functional class I or II. At discharge,
repair
80% of the patients had an MR grade #2, and at
(MitraClip, Abbott Vascular, Santa Clara, California)
1 month and 1 year after discharge this was 68% and
(2–4). The European Society of Cardiology guidelines
65%, respectively. During total follow-up, conven-
benefit
from
percutaneous
mitral
valve
prescribe a life expectancy >1 year to consider the procedure
(5).
As
current
clinical
data
are
insufficient to assess the survival in the first years after implantation, it is challenging for the physician to estimate the prognosis. Between January 2009 and January 2016, 618 consecutive
patients
treated
with
percutaneous
tional surgery was conducted in 1.9% (n ¼ 12), a second subsequent percutaneous mitral valve repair procedure was conducted in 3.4% (n ¼ 21), and a third percutaneous procedure was conducted in 0.2% (n ¼ 1). Multivariable Cox regression analysis showed that age, cardiac implantable electronic devices, previous valve surgery, NYHA functional class,
mitral valve repair in 5 Dutch hospitals were pro-
N-terminal pro–B-type natriuretic peptide levels, and
spectively followed. All patients were clinically
MR grade predicted survival after MitraClip implan-
evaluated #5 years, including echocardiography at
tation (Table 1). Among the high-risk patients
12 months post-implantation. The echocardiographic data
and
clinical
outcomes
were
self-reported.
Multivariable Cox regression, using stepwise forward selection, was performed to analyze the
T A B L E 1 Predictors of Mortality in Multivariable Analysis and
the Corresponding Risk Model Score
association of clinical characteristics with the surMultivariable Analysis
vival. A simplified risk stratification model was
HR (95% CI)
obtained by applying weights to individual predictors proportional to the hazard ratios of the
p Value
Risk Model Score
Age at procedure, yrs 70–79
2.7 (1.3–5.3)
0.006
2
$80
3.1 (1.5–6.3)
0.002
2
CIEDs
1.6 (1.2–2.2)
0.002
1
each category, with a higher score indicating a higher
Previous valve surgery
2.4 (1.5–3.9)
20%. In total, 451 (73%) patients were in New York
NT-proBNP, ng/l 2,000–4,999
1.7 (1.1–2.8)
0.031
1
$5,000
3.1 (1.9–5.2)
6 points), the median survival was 18 months, the was 8%. One month after MitraClip implantation,
3. Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve interventions in the real world: Early and 1-year results from the ACCESS-EU, A prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol 2013;62:
only 51% of these patients were in NYHA functional
1052–61.
1-year survival was 60%, and the 5-year survival
class I or II. For comparison, among the low-risk
4. Nickenig G, Estevez-Loureiro R, Franzen O, et al. Percutaneous mitral valve
patients (4,000
*Department of Cardiology
consecutive asymptomatic Asian participants under-
Academic Medical Center
going cardiovascular health screening from 2009 to
Room B2-252 Meibergdreef 9
2012 at a tertiary medical center in Taipei, Taiwan.
Amsterdam 1105 AZ
The setting, design, and exclusion criteria have been
the Netherlands
previously published (2). All participants underwent
E-mail:
[email protected]
comprehensive Doppler echocardiography including
http://dx.doi.org/10.1016/j.jacc.2017.03.602
left ventricular (LV) deformation assessment by
Please note: Dr. Van der Heyden has served as a proctor for Abbott Vascular MitraClip and Boston Lotus Valve. Dr. Baan has served as a proctor for Abbott Vascular MitraClip; and has received an unrestricted research grant from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
speckle tracking (version 10.8, EchoPAC, GE Vingmed Ultrasound,
Horten,
Norway)
to
define
global
longitudinal strain (GLS) (expressed as absolute values),
global
circumferential
strain
(GCS)
(expressed as absolute values), and cardiac torsion. LV mass index (LVMi) was calculated as LV mass/ REFERENCES 1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J 2003;24:1231–43. 2. Feldman T, Kar S, Rinaldi M, et al. Percutaneous mitral repair with the MitraClip system. Safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol 2009;54:686–94.
height 2.7.
BMI
cutoffs
were
used
to
classify
participants according to Public Health Action Trigger Points
recommended
by
2004
WHO
Expert
Consultation (Table 1) (1). The final cohort included a total of 4,031 participants with complete data. In the entire cohort (mean age 49.8 10.8 years, 65.2% men, mean BMI 24.3 3.6 kg/m 2), higher BMI
