Rudolph, Volker, Huntgeburth, Michael, von Bardeleben, Ralph Stephan, Boekstegers, Peter, Lubos, Edith, Schillinger, Wolfgang, Ouarrak, Taoufik, Eggebrecht, Holger, Butter, Christian, Plicht, Bjoern, May, Andreas, Franzen, Olaf, Schofer, Joachim, Senges, Jochen and Baldus, Stephan (2014). Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy. Eur. J. Heart Fail., 16 (11). S. 1223 - 1230. HOBOKEN: WILEY. ISSN 1879-0844

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Abstract

AimsAs periprocedural risk is low, MitraClip implantation is often performed in critically ill, not fully recompensated patients, who are in NYHA functional class IV at the time of the procedure, to accelerate convalescence. We herein sought to evaluate the procedural and 30-day outcome of this patient group. Methods and resultsA total of 803 patients undergoing MitraClip implantation were included in the German Mitral Valve Registry, and 30-day outcomes were prospectively assessed. Patients were separated based on NYHA functional class [(NYHA IV (n = 143), III (n = 572), and I/II (n = 88)]. No difference was noted in co-morbities and echocardiographic parameters of LV function between groups. However, parameters of severity of mitral regurgitation (MR) were higher in NYHA IV patients. High procedural success rates and low residual MR grades at discharge were observed throughout all groups. In-hospital major adverse cardiac events were similar between groups. Importantly, 30-day mortality (8.0% vs. 3.2% vs. 4.8%; P < 0.05) was significantly higher in NYHA IV patients, whereas rehospitalization did not differ between groups. At 30 days, 47.6% of NYHA IV patients were still in NYHA class III or IV compared with 32.5% and 14.8% in the other groups (P < 0.05), although NYHA functional class decreased in 69% of patients. Quality of life, which was very poor at baseline, showed an overall improvement in NYHA IV patients after 30 days, with, for example, a reduction of bed-ridden patients from 19.6% to 3.3%. ConclusionMitraClip therapy is feasible and safe even in critically ill, not fully recompensated patients and leads to symptomatic improvement in over two-thirds of these patients; however, it is associated with an elevated 30-day mortality.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Rudolph, VolkerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huntgeburth, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Bardeleben, Ralph StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boekstegers, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lubos, EdithUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schillinger, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ouarrak, TaoufikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eggebrecht, HolgerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Butter, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Plicht, BjoernUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
May, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Franzen, OlafUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schofer, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Senges, JochenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-425136
DOI: 10.1002/ejhf.169
Journal or Publication Title: Eur. J. Heart Fail.
Volume: 16
Number: 11
Page Range: S. 1223 - 1230
Date: 2014
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 1879-0844
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
TO-EDGE REPAIR; HEART-FAILURE; REGURGITATION; SURGERY; RISKMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/42513

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