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1. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation

Author

Rheude, Tobia, Costa, Giuliano, Ribichini, Flavio Luciano, Pilgrim, Thoma, Amat Santos, Ignacio J, De Backer, Ole, Kim, Won-Keun, Ribeiro, Henrique Barbosa, Saia, Francesco, Bunc, Matjaz, Tchetche, Didier, Garot, Philippe, Mylotte, Darren, Burzotta, Francesco, Watanabe, Yusuke, Bedogni, Francesco, Tesorio, Tullio, Tocci, Marco, Franzone, Anna, Valvo, Roberto, Savontaus, Mikko, Wienemann, Hendrik, Porto, Italo, Gandolfo, Caterina, Iadanza, Alessandro, Bortone, Alessandro S, Mach, Marku, Latib, Azeem, Biasco, Luigi, Taramasso, Maurizio, Zimarino, Marco, Tomii, Daijiro, Nuyens, Philippe, Sondergaard, Lar, Camara, Sergio F, Palmerini, Tullio, Orzalkiewicz, Mateusz, Steblovnik, Klemen, Degrelle, Bastien, Gautier, Alexandre, Del Sole, Paolo Alberto, Mainardi, Andrea, Pighi, Michele, Lunardi, Mattia, Kawashima, Hideyuki, Criscione, Enrico, Cesario, Vincenzo, Biancari, Fausto, Zanin, Federico, Esposito, Giovanni, Adam, Matti, Grube, Eberhard, Baldus, Stephan, De Marzo, Vincenzo, Piredda, Elisa, Cannata, Stefano, Iacovelli, Fortunato, Andreas, Martin, Frittitta, Valentina, Dipietro, Elena, Reddavid, Claudia, Strazzieri, Orazio, Motta, Silvia, Angellotti, Domenico, Sgroi, Carmelo, Xhepa, Erion, Kargoli, Faraj, Tamburino, Corrado, Joner, Michael, Barbanti, Marco, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Porto, Italo (ORCID:0000-0002-9854-5046), Rheude, Tobia, Costa, Giuliano, Ribichini, Flavio Luciano, Pilgrim, Thoma, Amat Santos, Ignacio J, De Backer, Ole, Kim, Won-Keun, Ribeiro, Henrique Barbosa, Saia, Francesco, Bunc, Matjaz, Tchetche, Didier, Garot, Philippe, Mylotte, Darren, Burzotta, Francesco, Watanabe, Yusuke, Bedogni, Francesco, Tesorio, Tullio, Tocci, Marco, Franzone, Anna, Valvo, Roberto, Savontaus, Mikko, Wienemann, Hendrik, Porto, Italo, Gandolfo, Caterina, Iadanza, Alessandro, Bortone, Alessandro S, Mach, Marku, Latib, Azeem, Biasco, Luigi, Taramasso, Maurizio, Zimarino, Marco, Tomii, Daijiro, Nuyens, Philippe, Sondergaard, Lar, Camara, Sergio F, Palmerini, Tullio, Orzalkiewicz, Mateusz, Steblovnik, Klemen, Degrelle, Bastien, Gautier, Alexandre, Del Sole, Paolo Alberto, Mainardi, Andrea, Pighi, Michele, Lunardi, Mattia, Kawashima, Hideyuki, Criscione, Enrico, Cesario, Vincenzo, Biancari, Fausto, Zanin, Federico, Esposito, Giovanni, Adam, Matti, Grube, Eberhard, Baldus, Stephan, De Marzo, Vincenzo, Piredda, Elisa, Cannata, Stefano, Iacovelli, Fortunato, Andreas, Martin, Frittitta, Valentina, Dipietro, Elena, Reddavid, Claudia, Strazzieri, Orazio, Motta, Silvia, Angellotti, Domenico, Sgroi, Carmelo, Xhepa, Erion, Kargoli, Faraj, Tamburino, Corrado, Joner, Michael, Barbanti, Marco, Burzotta, Francesco (ORCID:0000-0002-6569-9401), and Porto, Italo (ORCID:0000-0002-9854-5046)

Abstract

Background: The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. Aims: We sought to compare different PCI timing strategies in TAVI patients. Methods: The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. Results: A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. Conclusions: In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.

Published
2023

2. Procedural success in transaxillary transcatheter aortic valve implantation according to type of transcatheter heart valve: results from the multicenter TAXI registry

Author

Schaefer, Andrea, Bhadra, Oliver D, Conradi, Lenard, Westermann, Dirk, Kellner, Caroline, De Backer, Ole, Bajoras, Vilhelma, Sondergaard, Lar, Qureshi, Waqas T, Kakouros, Nikolao, Aldrugh, Summer, Amat-Santos, Ignacio, Kaneko, Tsuyoshi, Harloff, Morgan, Teles, Rui, Nolasco, Tiago, Neves, Jose Pedro, Abecasis, Miguel, Werner, Niko, Lauterbach, Michael, Sacha, Jerzy, Krawczyk, Krzysztof, Trani, Carlo, Romagnoli, Enrico, Mangieri, Antonio, Condello, Francesco, Regueiro, Ander, Brugaletta, Salvatore, Biancari, Fausto, Niemelä, Matti, Giannini, Francesco, Toselli, Marco, Ruggiero, Rossella, Buono, Andrea, Maffeo, Diego, Bruno, Francesco, Conrotto, Federico, D'Ascenzo, Fabrizio, Savontaus, Mikko, Pykäri, Jouni, Ielasi, Alfonso, Tespili, Maurizio, Cimmino, Michele, Albanese, Michele, Biondi-Zoccai, Giuseppe, Corcione, Nicola, Morello, Alberto, Giordano, Arturo, Trani, Carlo (ORCID:0000-0001-9777-013X), Schaefer, Andrea, Bhadra, Oliver D, Conradi, Lenard, Westermann, Dirk, Kellner, Caroline, De Backer, Ole, Bajoras, Vilhelma, Sondergaard, Lar, Qureshi, Waqas T, Kakouros, Nikolao, Aldrugh, Summer, Amat-Santos, Ignacio, Kaneko, Tsuyoshi, Harloff, Morgan, Teles, Rui, Nolasco, Tiago, Neves, Jose Pedro, Abecasis, Miguel, Werner, Niko, Lauterbach, Michael, Sacha, Jerzy, Krawczyk, Krzysztof, Trani, Carlo, Romagnoli, Enrico, Mangieri, Antonio, Condello, Francesco, Regueiro, Ander, Brugaletta, Salvatore, Biancari, Fausto, Niemelä, Matti, Giannini, Francesco, Toselli, Marco, Ruggiero, Rossella, Buono, Andrea, Maffeo, Diego, Bruno, Francesco, Conrotto, Federico, D'Ascenzo, Fabrizio, Savontaus, Mikko, Pykäri, Jouni, Ielasi, Alfonso, Tespili, Maurizio, Cimmino, Michele, Albanese, Michele, Biondi-Zoccai, Giuseppe, Corcione, Nicola, Morello, Alberto, Giordano, Arturo, and Trani, Carlo (ORCID:0000-0001-9777-013X)

Abstract

Background: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. Aims: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). Methods: For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. Results: From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation. Conclusions: Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.

Published
2023

3. Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

Author

Costa, Giuliano, Pilgrim, Thoma, Amat Santos, Ignacio J, De Backer, Ole, Kim, Won-Keun, Barbosa Ribeiro, Henrique, Saia, Francesco, Bunc, Matjaz, Tchetche, Didier, Garot, Philippe, Ribichini, Flavio Luciano, Mylotte, Dzxcfewarren, Burzotta, Francesco, Watanabe, Yusuke, De Marco, Federico, Tesorio, Tullio, Rheude, Tobia, Tocci, Marco, Franzone, Anna, Valvo, Roberto, Savontaus, Mikko, Wienemann, Hendrik, Porto, Italo, Gandolfo, Caterina, Iadanza, Alessandro, Bortone, Alessandro Santo, Mach, Marku, Latib, Azeem, Biasco, Luigi, Taramasso, Maurizio, Zimarino, Marco, Tomii, Daijiro, Nuyens, Philippe, Sondergaard, Lar, Camara, Sergio F, Palmerini, Tullio, Orzalkiewicz, Mateusz, Steblovnik, Klemen, Degrelle, Bastien, Gautier, Alexandre, Del Sole, Paolo Alberto, Mainardi, Andrea, Pighi, Michele, Lunardi, Mattia, Kawashima, Hideyuki, Criscione, Enrico, Cesario, Vincenzo, Biancari, Fausto, Zanin, Federico, Joner, Michael, Esposito, Giovanni, Adam, Matti, Grube, Eberhard, Baldus, Stephan, De Marzo, Vincenzo, Piredda, Elisa, Cannata, Stefano, Iacovelli, Fortunato, Andreas, Martin, Frittitta, Valentina, Dipietro, Elena, Reddavid, Claudia, Strazzieri, Orazio, Motta, Silvia, Angellotti, Domenico, Sgroi, Carmelo, Kargoli, Faraj, Tamburino, Corrado, Barbanti, Marco, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Porto, Italo (ORCID:0000-0002-9854-5046), Costa, Giuliano, Pilgrim, Thoma, Amat Santos, Ignacio J, De Backer, Ole, Kim, Won-Keun, Barbosa Ribeiro, Henrique, Saia, Francesco, Bunc, Matjaz, Tchetche, Didier, Garot, Philippe, Ribichini, Flavio Luciano, Mylotte, Dzxcfewarren, Burzotta, Francesco, Watanabe, Yusuke, De Marco, Federico, Tesorio, Tullio, Rheude, Tobia, Tocci, Marco, Franzone, Anna, Valvo, Roberto, Savontaus, Mikko, Wienemann, Hendrik, Porto, Italo, Gandolfo, Caterina, Iadanza, Alessandro, Bortone, Alessandro Santo, Mach, Marku, Latib, Azeem, Biasco, Luigi, Taramasso, Maurizio, Zimarino, Marco, Tomii, Daijiro, Nuyens, Philippe, Sondergaard, Lar, Camara, Sergio F, Palmerini, Tullio, Orzalkiewicz, Mateusz, Steblovnik, Klemen, Degrelle, Bastien, Gautier, Alexandre, Del Sole, Paolo Alberto, Mainardi, Andrea, Pighi, Michele, Lunardi, Mattia, Kawashima, Hideyuki, Criscione, Enrico, Cesario, Vincenzo, Biancari, Fausto, Zanin, Federico, Joner, Michael, Esposito, Giovanni, Adam, Matti, Grube, Eberhard, Baldus, Stephan, De Marzo, Vincenzo, Piredda, Elisa, Cannata, Stefano, Iacovelli, Fortunato, Andreas, Martin, Frittitta, Valentina, Dipietro, Elena, Reddavid, Claudia, Strazzieri, Orazio, Motta, Silvia, Angellotti, Domenico, Sgroi, Carmelo, Kargoli, Faraj, Tamburino, Corrado, Barbanti, Marco, Burzotta, Francesco (ORCID:0000-0002-6569-9401), and Porto, Italo (ORCID:0000-0002-9854-5046)

Abstract

Background:The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. Methods:The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. Results:Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio, 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio, 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). Conclusions:The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged o

Published
2022

4. Percutaneous vs surgical axillary access for transcatheter aortic valve implantation: the TAXI registry

Author

Giordano, Arturo, Schaefer, Andrea, Bhadra, Oliver D, Conradi, Lenard, Westermann, Dirk, DE Backer, Ole, Bajoras, Vilhelma, Sondergaard, Lar, Qureshi, Waqas T, Kakouros, Nikolao, Aldrugh, Summer, Amat-Santos, Ignacio, Santos Martínez, Sandra, Kaneko, Tsuyoshi, Harloff, Morgan, Teles, Rui, Nolasco, Tiago, Neves, Jose P, Abecasis, Miguel, Werner, Niko, Lauterbach, Michael, Sacha, Jerzy, Krawczyk, Krzysztof, Trani, Carlo, Romagnoli, Enrico, Mangieri, Antonio, Condello, Francesco, Regueiro, Ander, Brugaletta, Salvatore, Biancari, Fausto, Niemelä, Matti, Giannini, Francesco, Toselli, Marco, Ruggiero, Rossella, Buono, Andrea, Maffeo, Diego, Bruno, Francesco, Conrotto, Federico, D'Ascenzo, Fabrizio, Savontaus, Mikko, Pykäri, Jouni, Ielasi, Alfonso, Tespili, Maurizio, Corcione, Nicola, Ferraro, Paolo, Morello, Alberto, Albanese, Michele, Biondi-Zoccai, Giuseppe, Trani, Carlo (ORCID:0000-0001-9777-013X), Giordano, Arturo, Schaefer, Andrea, Bhadra, Oliver D, Conradi, Lenard, Westermann, Dirk, DE Backer, Ole, Bajoras, Vilhelma, Sondergaard, Lar, Qureshi, Waqas T, Kakouros, Nikolao, Aldrugh, Summer, Amat-Santos, Ignacio, Santos Martínez, Sandra, Kaneko, Tsuyoshi, Harloff, Morgan, Teles, Rui, Nolasco, Tiago, Neves, Jose P, Abecasis, Miguel, Werner, Niko, Lauterbach, Michael, Sacha, Jerzy, Krawczyk, Krzysztof, Trani, Carlo, Romagnoli, Enrico, Mangieri, Antonio, Condello, Francesco, Regueiro, Ander, Brugaletta, Salvatore, Biancari, Fausto, Niemelä, Matti, Giannini, Francesco, Toselli, Marco, Ruggiero, Rossella, Buono, Andrea, Maffeo, Diego, Bruno, Francesco, Conrotto, Federico, D'Ascenzo, Fabrizio, Savontaus, Mikko, Pykäri, Jouni, Ielasi, Alfonso, Tespili, Maurizio, Corcione, Nicola, Ferraro, Paolo, Morello, Alberto, Albanese, Michele, Biondi-Zoccai, Giuseppe, and Trani, Carlo (ORCID:0000-0001-9777-013X)

Abstract

N/A

Published
2022

5. Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: the TRANSIT-PPM international project

Author

Testa, Luca, Casenghi, Matteo, Criscione, Enrico, Van Mieghem, Nicolas M, Tchétché, Didier, Asgar, Anita W, De Backer, Ole, Latib, Azeem, Reimers, Bernhard, Stefanini, Giulio, Trani, Carlo, Giannini, Francesco, Bartorelli, Antonio, Wojakowski, Wojtek, Dabrowski, Maciej, Jagielak, Dariusz, Banning, Adrian P, Kharbanda, Rajesh, Moreno, Raul, Schofer, Joachim, Brinkmann, Christina, van Royen, Niel, Pinto, Duane, Serra, Antoni, Segev, Amit, Giordano, Arturo, Brambilla, Nedy, Agnifili, Mauro, Rubbio, Antonio Popolo, Squillace, Mattia, Oreglia, Jacopo, Tanja, Rudolph, Mccabe, James M, Abizaid, Alexander, Voskuil, Michiel, Teles, Rui, Zoccai, Giuseppe Biondi, Sondergaard, Lar, Bedogni, Francesco, Trani, Carlo (ORCID:0000-0001-9777-013X), Testa, Luca, Casenghi, Matteo, Criscione, Enrico, Van Mieghem, Nicolas M, Tchétché, Didier, Asgar, Anita W, De Backer, Ole, Latib, Azeem, Reimers, Bernhard, Stefanini, Giulio, Trani, Carlo, Giannini, Francesco, Bartorelli, Antonio, Wojakowski, Wojtek, Dabrowski, Maciej, Jagielak, Dariusz, Banning, Adrian P, Kharbanda, Rajesh, Moreno, Raul, Schofer, Joachim, Brinkmann, Christina, van Royen, Niel, Pinto, Duane, Serra, Antoni, Segev, Amit, Giordano, Arturo, Brambilla, Nedy, Agnifili, Mauro, Rubbio, Antonio Popolo, Squillace, Mattia, Oreglia, Jacopo, Tanja, Rudolph, Mccabe, James M, Abizaid, Alexander, Voskuil, Michiel, Teles, Rui, Zoccai, Giuseppe Biondi, Sondergaard, Lar, Bedogni, Francesco, and Trani, Carlo (ORCID:0000-0001-9777-013X)

Abstract

Background: A severe prosthesis-patient mismatch (PPM) is associated with adverse outcomes following transcatheter aortic valve replacement (TAVR) for de novo aortic stenosis or a failed surgical bioprosthesis. The impact of severe PPM in patients undergoing TAV-in-TAVR is unknown. Aim: We sought to investigate the incidence and 1-year outcomes of different grades of PPM in patients undergoing TAV-in-TAVR. Materials and methods: The TRANSIT-PPM is an international registry, including cases of degenerated TAVR treated with a second TAVR. PPM severity, as well as in-hospital, 30-day, and 1-year outcomes were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria. Results: Among 28 centers, 155 patients were included. Severe PPM was found in 6.5% of patients, whereas moderate PPM was found in 14.2% of patients. The rate of severe PPM was higher in patients who underwent TAV-in-TAVR with a second supra-annular self-expanding (S-SE) TAVR (10%, p = 0.04). Specifically, the rate of severe PPM was significantly higher among cases of a SE TAVR implanted into a balloon-expandable (BE) device (19%, p = 0.003). At 1-year follow-up, the rate of all-cause mortality, and the rate of patients in the New York Heart Association (NYHA) class III/IV were significantly higher in the cohort of patients with severe PPM (p = 0.016 and p = 0.0001, respectively). Almost all the patients with a severe PPM after the first TAVR had a failed < 23 mm BE transcatheter heart valve (THV): the treatment with an S-SE resolved the severe PPM in the majority of the cases. Conclusion: After TAV-in-TAVR, in a fifth of the cases, a moderate or severe PPM occurred. A severe PPM is associated with an increased 1-year all-cause mortality.

Published
2022

6. Effect of Gender on Results of Percutaneous Edge-to-Edge Mitral Valve Repair With MitraClip System

Author

Per Jacobsen, Neil Moat, Nikolaj Ihlemann, Olaf Franzen, Rodrigo Estévez-Loureiro, Susanna Price, Gary Cheung, Lars Søndergaard, Carlo Di Mario, Michele Pighi, Gianni Dall'Ara, Matteo Ghione, Magnus Settergren, Tine Streit Rosenberg, Reidar Winter, Estévez-Loureiro, Rodrigo, Settergren, Magnu, Winter, Reidar, Jacobsen, Per, Dall'ara, Gianni, Sondergaard, Lar, Cheung, Gary, Pighi, Michele, Ghione, Matteo, Ihlemann, Nikolaj, Moat, Neil E., Price, Susanna, Streit Rosenberg, Tine, Di Mario, Carlo, and Franzen, Olaf

Subjects
Male, medicine.medical_specialty, Percutaneous, Denmark, medicine.medical_treatment, Sex Factor, Kaplan-Meier Estimate, Prosthesis Design, Follow-Up Studie, Postoperative Complications, Sex Factors, Retrospective Studie, Internal medicine, medicine, Humans, Myocardial infarction, Survival rate, Aged, Retrospective Studies, Sweden, Mitral regurgitation, Mitral valve repair, business.industry, Incidence, MitraClip, Mitral Valve Insufficiency, Retrospective cohort study, medicine.disease, United Kingdom, Surgery, Survival Rate, Heart Valve Prosthesi, Treatment Outcome, Female, Follow-Up Studies, Heart Valve Prosthesis, Cohort, Cardiology, Postoperative Complication, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Knowledge regarding gender-specific results of percutaneous edge-to-edge mitral valve repair is scarce. The aim of this study was to investigate gender differences in outcomes in a cohort of patients treated with MitraClip implantation. A multicenter registry of 173 patients treated with MitraClip prostheses from 2009 to 2012 at 3 experienced centers was performed. One hundred nine patients (63%) were men. Men were younger (mean age 73 ± 10 vs 79 ± 9 years, p = 0.001) and had a higher prevalence of previous coronary bypass graft surgery (34% vs 13%, p = 0.002), previous myocardial infarction (46% vs 20%, p = 0.001), and diabetes mellitus (26% vs 11%, p = 0.020). There were no differences regarding New York Heart Association (NYHA) functional class before the intervention (NYHA class III or IV in 95% of men vs 97% of women, p = 0.472) or the cause of mitral regurgitation (MR) (functional in 58% of men vs 48% of women, p = 0.233). Men exhibited significantly larger ventricles (mean indexed left ventricular end-systolic diameter 2.4 ± 0.8 vs 2.0 ± 1.6 cm/m2, p = 0.002, and mean indexed left ventricular end-diastolic volume 92.7 ± 46.1 vs 59.9 ± 24.6 ml/m2, p

Published
2015
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7. Effect of advanced chronic kidney disease in clinical and echocardiographic outcomes of patients treated with MitraClip system

Author

Gary Cheung, Per Jacobsen, Susanna Price, Magnus Settergren, Olaf Franzen, Rodrigo Estévez-Loureiro, Gianni Dall'Ara, Carlo Di Mario, Neil Moat, Nikolaj Ihlemann, Lars Søndergaard, Matteo Ghione, Michele Pighi, Tine Streit Rosenberg, Reidar Winter, Estévez-Loureiro, Rodrigo, Settergren, Magnu, Pighi, Michele, Winter, Reidar, Dall'Ara, Gianni, Jacobsen, Per, Sondergaard, Lar, Cheung, Gary, Ghione, Matteo, Ihlemann, Nikolaj, Moat, Neil E., Price, Susanna, Rosenberg, Tine Streit, Di Mario, Carlo, and Franzen, Olaf

Subjects
Registrie, Male, medicine.medical_specialty, Renal function, Surgical Instrument, Nyha class, Follow-Up Studie, Catheter-based therapy, Chronic kidney disease, Mitral regurgitation, Aged, Aged, 80 and over, Echocardiography, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation, Humans, Middle Aged, Mitral Valve Insufficiency, Registries, Renal Insufficiency, Chronic, Survival Rate, Treatment Outcome, Surgical Instruments, Internal medicine, 80 and over, Medicine, Renal Insufficiency, Chronic, Adverse effect, Survival rate, business.industry, MitraClip, Background data, medicine.disease, Cohort, Cardiology, business, Cardiology and Cardiovascular Medicine, Kidney disease, Human
Abstract

Background Data regarding the influence of different levels of renal dysfunction on clinical and echocardiographic results of MitraClip therapy are scarce. We aimed to evaluate the impact of baseline advance renal failure in the outcomes of a cohort of patients treated with MitraClip. Methods and results We analyzed data from a multicenter registry of 173 patients treated with MitraClip between 2009 and 2012. Patients were classified as advanced chronic kidney disease (CKD, creatinine clearance [CrCl] < 30 ml/min, group 1, n = 20), moderate CKD (CrCl 30-60 ml/min, group 2, n = 78) and normal renal function (CrCl > 60 ml/min, group 3, n = 75). Twenty patients (11.5%) presented advanced CKD. Procedural success was equal in the 3 groups (95.0% group 1, 100% in group 2 and 96.0% in group 3, p = 0.180). Post-procedural MR and NYHA class at 1 month (MR ≥ 3 + 5.0% vs. 0% vs. 4.0% p = 0.190 and NYHA > II 40.0% vs. 21.0% vs. 18.3%, p = 0.101) and 6 months (MR ≥ 3 + 0% vs. 13.0% vs. 2.7%, p = 0.330; and NYHA class > II 54.5% vs. 26.9% vs. 25.6%, p = 0.298) did not differ between groups. However, patients in group 1 experienced higher frequency of the composite end-point of mortality or readmission at 16.2 ± 11.1 months of follow-up (HR 4.8, CI 95% 1.1-21.3). Conclusion Advanced CKD is linked to an excess of cardiac adverse events. This should be judiciously taken into account when selecting patients for MitraClip.

Published
2015

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