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

Cosmo Godino, Andrea Munafò, Andrea Scotti, Rodrigo Estévez-Loureiro, Antonio Portolés Hernández, Dabit Arzamendi, Estefanía Fernández Peregrina, Maurizio Taramasso, Neil P. Fam, Edwin C. Ho, Anita Asgar, Giancarlo Vitrella, Claudia Raineri, Marianna Adamo, Claudia Fiorina, Claudio Montalto, Chiara Fraccaro, Cristina Giannini, Francesca Fiorelli, Antonio Popolo RubbioJ. F. Ooms, Miriam Compagnone, Diego Maffeo, Luca Bettari, Monika Fürholz, Corrado Tamburino, A. Sonia Petronio, Carmelo Grasso, Eustachio Agricola, Nicolas M. Van Mieghem, Giuseppe Tarantini, Salvatore Curello, Fabien Praz, Isaac Pascual, Luciano Potena, Antonio Colombo, Francesco Maisano, Marco Metra, Alberto Margonato, Gabriele Crimi, Francesco Saia

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1353-1362
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number12
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • advanced heart failure
  • heart transplantation
  • MitraClip
  • secondary mitral regurgitation
  • transcatheter mitral valve intervention

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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