MitraClip in secondary mitral regurgitation as a bridge to heart transplantation: 1-year outcomes from the International MitraBridge Registry

https://doi.org/10.1016/j.healun.2020.09.005Get rights and content

BACKGROUND

Patients awaiting heart transplantation (HTx) often need bridging therapies to reduce worsening and progression of underlying disease. Limited data are available regarding the use of the MitraClip procedure in secondary mitral regurgitation for this clinical condition.

METHODS

We evaluated an international, multicenter (17 centers) registry including 119 patients (median age: 58 years) with moderate-to-severe or severe secondary mitral regurgitation and advanced heart failure (HF) (median left ventricular ejection fraction: 26%) treated with MitraClip as a bridge strategy according to 1 of the following criteria: (1) patients active on HTx list (in list group) (n = 31); (2) patients suitable for HTx but awaiting clinical decision (bridge to decision group) (n = 54); or (3) patients not yet suitable for HTx because of potentially reversible relative contraindications (bridge to candidacy group) (n = 34).

RESULTS

Procedural success was achieved in 87.5% of cases, and 30-day survival was 100%. At 1 year, Kaplan–Meier estimates of freedom from the composite primary end-point (death, urgent HTx or left ventricular assist device implantation, first rehospitalization for HF) was 64%. At the time of last available follow-up (median: 532 days), 15% of patients underwent elective transplant, 15.5% remained or could be included in the HTx waiting list, and 23.5% had no more indication to HTx because of clinical improvement.

CONCLUSIONS

MitraClip procedure as a bridge strategy to HTx in patients with advanced HF with significant mitral regurgitation was safe, and two thirds of patients remained free from adverse events at 1 year. These findings should be considered exploratory and hypothesis-generating to guide further study for percutaneous intervention in high-risk patients with advanced HF.

Section snippets

Registry study design

MitraBridge is a multicenter observational registry, including all consecutive patients with chronic advanced HF (defined as New York Heart Association [NYHA] III or IV and/or left ventricular ejection fraction [LVEF] ≤ 30% and according to the recently updated definitions proposed by the Heart Failure Association of the European Society of Cardiology3) and concomitant moderate-to-severe or severe secondary (or functional) MR being potential candidates for HTx. The registry was initiated in

Study population and demographics

In the MitraBridge registry, 119 patients with moderate-to-severe or severe secondary MR and advanced HF across 17 centers (in Italy, Switzerland, the Netherlands, Spain, and Canada) have been included. The median age of the treated population was 58 years (25th–75th percentile: 51–63 years), with 59% of patients ≤60 years old. Before MitraClip procedure, all patients were on guideline-directed medical therapy as tolerated (Table 1). Hospitalization for HF within the previous 6 months was

Discussion

This is a multicenter, international registry reporting data in patients with advanced HF with significant secondary MR and the MitraClip procedure as a bridge to transplant strategy. The main findings demonstrate the following: (1) the selected use of MitraClip as a bridge strategy to HTx was safe (87.5% procedural success and no death at 30 days) and effective; (2) two thirds of patients remain free of development of composite adverse events at 1 year (primary end-point); (3) 15.5% became

Disclosure statement

Dr Rodrigo Estévez-Loureiro reports receiving grants and personal fees from Abbott during the conduct of the study. The remaining authors have no conflicts of interest to declare.

References (26)

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