1. Transcatheter Mitral Valve Repair With the MitraClip Device for Prior Mitral Valve Repair Failure: Insights From the GIOTTO-FAILS Study.
- Author
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Giordano A, Ferraro P, Finizio F, Corcione N, Cimmino M, Biondi-Zoccai G, Denti P, Rubbio AP, Petronio AS, Bartorelli AL, Mongiardo A, Giordano S, De Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario M, Fiocca L, Castriota F, Squeri A, Tamburino C, and Bedogni F
- Subjects
- Humans, Male, Female, Aged, Italy epidemiology, Aged, 80 and over, Patient Readmission statistics & numerical data, Treatment Failure, Heart Valve Prosthesis, Mitral Valve Annuloplasty instrumentation, Mitral Valve Annuloplasty adverse effects, Treatment Outcome, Time Factors, Risk Factors, Heart Failure mortality, Heart Failure physiopathology, Heart Failure surgery, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency diagnostic imaging, Cardiac Catheterization instrumentation, Cardiac Catheterization methods, Registries, Mitral Valve surgery, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods
- Abstract
Background: Minimally invasive mitral valve repair has a favorable risk-benefit profile in patients with significant de novo mitral regurgitation. Its role in patients with prior mitral valve repair is uncertain. We aimed to appraise the outcome of patients undergoing transcatheter edge-to-edge repair (TEER) with prior transcatheter or surgical mitral valve repair (SMVR)., Methods and Results: We queried the Italian multicenter registry on TEER with MitraClip, distinguishing naïve patients from those with prior TEER or (SMVR). Inhospital and long-term clinical/echocardiographic outcomes were appraised. The primary outcome was the occurrence of death or rehospitalization for heart failure. A total of 2238 patients were included, with 2169 (96.9%) who were naïve to any mitral intervention, 29 (1.3%) with prior TEER, and 40 (1.8%) with prior SMVR. Several significant differences were found in baseline clinical and imaging features. Respectively, device success was obtained in 2120 (97.7%), 28 (96.6%), and 38 (95.0%, P =0.261) patients; procedural success in 2080 (95.9%), 25 (86.2%), and 38 (95.0%; P =0.047); and inhospital death in 61 (2.8%), 1 (3.5%), and no ( P =0.558) patients. Clinical follow-up after a mean of 14 months showed similar rates of death, cardiac death, rehospitalization, rehospitalization for heart failure, and their composite (all P >0.05). Propensity score-adjusted analysis confirmed unadjusted analysis, with lower procedural success for the prior TEER group (odds ratio, 0.28 [95% CI, 0.09-0.81]; P =0.019) but similar odds ratios and hazard ratios for all other outcomes in the naïve, TEER, and SMVR groups (all P >0.05)., Conclusions: In carefully selected patients, TEER can be performed using the MitraClip device even after prior TEER or SMVR.
- Published
- 2024
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