Korean Circ J.  2019 Jun;49(6):532-541. 10.4070/kcj.2018.0417.

Can Elderly Patients with Severe Mitral Regurgitation Benefit from Trans-catheter Mitral Valve Repair?

• Lee CW
• Sung SH
• Huang WM
• Tsai YL
• Chen HY
• Hsu CP
• Shih CC
• Chung KP

• KMID: 2454049
• DOI: http://doi.org/10.4070/kcj.2018.0417

Abstract

BACKGROUND AND OBJECTIVES
Age is a traditional risk factor for open-heart surgery. The efficacy and safety of transcatheter edge-to-edge mitral valve repair, using MitraClip (Abbott Vascular), has been demonstrated in patients with severe mitral regurgitation (MR). Since octogenarians or older patients are usually deferred to receive open-heart surgery, the main interest of this study is to elucidate the procedural safety and long-term clinical impact of MitraClip in elderly patients.
METHODS
Patients with symptomatic severe MR were evaluated by the heart team. For those with high or prohibitive surgical risks, transcatheter mitral valve repair was performed in hybrid operation room. Transthoracic echocardiography (TTE), blood tests, and six-minute walk test (6MWT) were performed before, 1-month, 6-months, and 1 year after index procedure.
RESULTS
A total of 46 consecutive patients receiving MitraClip procedure were enrolled. Nineteen patients (84.2±4.0 years) were over 80-year-old and 27 (73.4±11.1 years) were younger than 80. Compare to baseline, the significant reduction in MR severity was achieved after the procedure and sustained. All the patients benefited from significant improvement in New York Heart Association functional class. The 6-minute walk test (6MWT) increased from 259±114 to 319±92 meters (p=0.03) at 1 year. The overall 1-year survival rate was 80% in the elderly and 88% in those <80 years, p=0.590. Baseline 6MWT was a predictor for all-cause mortality (odds ratio, 0.99; 95% confidence interval, 0.982-0.999; p=0.026) after the MitraClip procedure.
CONCLUSIONS
Trans-catheter edge-to-edge mitral valve repairs are safe and have positive clinical impact in subjects with severe MR, even in advanced age.

Keyword

Elderly; Mitral regurgitation

MeSH Terms

Aged*
Aged, 80 and over
Echocardiography
Heart
Hematologic Tests
Humans
Mitral Valve Insufficiency*
Mitral Valve*
Mortality
Risk Factors
Survival Rate

Figure

• 

  Figure 1 Patients flow for management of patients with symptomatic severe MR. DMR = degenerative mitral regurgitation; FMR = functional mitral regurgitation; GDMT = goal-directed medical treatment; MR = mitral regurgitation; SMVR = surgical mitral valve replacement/repair; TMVR = transcatheter mitral valve repair.

• 

  Figure 2 (A) Results for NYHA Fc improvement before, 1, 6, and 12 months after clip implantation. (B) Results for MR reduction before, 1, 6, and 12 months after clip implantation. NYHA Fc = New York Heart Failure Association functional class.

• 

  Figure 3 (A) Results for Ln NT-proBNP before, 1, 6, and 12 months after clip implantation. (B) Results for 6MWT distance (meters) before, 1, 6, and 12 months after clip implantation. 6MWT = 6-minute walk test; NT-proBNP = N-terminal pro-B type natriuretic peptide.

• 

  Figure 4 Kaplan-Meier curves at 1-year follow-up. (A) Freedom from all-cause death. (B) Freedom from all-cause death or re-admission for heart failure.

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