Universität zu Köln

Lubos, Edith, Schlueter, Michael, Vettorazzi, Eik ORCID: 0000-0002-3737-6402, Goldmann, Britta, Lubs, Daniel, Schirmer, Johannes, Treede, Hendrik, Reichenspurner, Hermann, Blankenberg, Stefan, Baldus, Stephan and Rudolph, Volker (2014). MitraClip Therapy in Surgical High-Risk Patients Identification of Echocardiographic Variables Affecting Acute Procedural Outcome. JACC-Cardiovasc. Interv., 7 (4). S. 394 - 403. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7605

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Abstract

Objectives The aim of the study was to assess predictors of acute procedural failure in surgical high-risk patients undergoing MitraClip (Abbott Vascular, Abbott Park, Illinois) therapy. Background MitraClip implantation is a novel percutaneous option to treat significant mitral regurgitation (MR). Methods In 300 patients (75 +/- 9 years of age, 190 [63%] men), of whom 32 (10.7%) had been unsuccessfully treated (discharge MR grade of >2+), baseline clinical and echocardiographic variables were evaluated by exact logistic regression and classification tree analyses to assess their impact on acute procedural failure. Acute procedural failure was differentiated into aborted procedure (no MitraClip implanted; n = 11) and clip failure (inadequate MR reduction despite MitraClip implantation; n = 21). Results Multivariate logistic regression identified effective regurgitant orifice area (EROA), mitral valve orifice area (MVOA), and mean transmitral pressure gradient (TMPG) as independent predictors of overall acute procedural failure. Classification tree analysis revealed that an EROA > 70.8 mm(2) (n = 28) was associated with a high rate (25%) of clip failures, whereas the combination of an MVOA <= 3.0 cm(2) and a TMPG >= 4mmHg (n = 16) was associated with a high rate (37.5%) of aborted procedures. Failure rates of <= 10% were observed in all patients with an EROA <= 70.8 mm(2) and either an MVOA> 3.0 cm(2) (n 217) or an MVOA <= 3.0 cm(2) in concert with a TMPG <= 3mm Hg (n = 39). Multinomial logistic regression identified an EROA > 70.8 mm(2) and a TMPG >= 4 mm Hg as independently predictive of clip failure, but an MVOA <= 3.0 cm(2) and a TMPG >= 4 mm Hg as independently predictive of procedure abortion. Conclusions In surgical high-risk patients undergoing MitraClip therapy, a TMPG >= 4 mm Hg, an EROA >= 70.8 mm(2), and an MVOA <= 3.0 cm(2) carry an increased risk of procedural failure. (C) 2014 by the American College of Cardiology Foundation

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lubos, Edith UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlueter, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Vettorazzi, Eik UNSPECIFIED orcid.org/0000-0002-3737-6402 UNSPECIFIED Goldmann, Britta UNSPECIFIED UNSPECIFIED UNSPECIFIED Lubs, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Schirmer, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Treede, Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Reichenspurner, Hermann UNSPECIFIED UNSPECIFIED UNSPECIFIED Blankenberg, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-441542
DOI:	10.1016/j.jcin.2013.12.198
Journal or Publication Title:	JACC-Cardiovasc. Interv.
Volume:	7
Number:	4
Page Range:	S. 394 - 403
Date:	2014
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1876-7605
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NATIVE VALVULAR REGURGITATION; CLINICAL-PRACTICE; RECOMMENDATIONS; SURGERY; SEVERITY; REPAIR; SYSTEM; TRIAL Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44154