Comparison of Outcome After Percutaneous Mitral Valve Repair With the MitraClip in Patients With Versus Without Atrial Fibrillation.

Abstract

Percutaneous mitral valve repair with the MitraClip is an established treatment for patients with mitral regurgitation (MR) who are inoperable or at high risk for surgery. Atrial Fibrillation (AF) frequently coincides with MR, but only scarce data of the influence of AF on outcome after MitraClip is available. The aim of the current study was to compare the clinical outcome after MitraClip treatment in patients with versus without atrial fibrillation. Between January 2009 and January 2016, all consecutive patients treated with a MitraClip in 5 Dutch centers were included. Outcome measures were survival, symptoms, MR grade, and stroke incidence. In total, 618 patients were treated with a MitraClip. Patients with AF were older, had higher N-terminal B-type natriuretic peptide levels, more tricuspid regurgitation, less often coronary artery disease and a better left ventricular function. Survival of patients treated with the MitraClip was similar for patients with AF (82%) and without AF (non-AF; 85%) after 1 year (p = 0.30), but significantly different after 5-year follow-up (AF 34%; non-AF 47%; p = 0.006). After 1 month, 64% of the patients with AF were in New York Heart Association class I or II, in contrast to 77% of the patients without AF (p = 0.001). The stroke incidence appeared not to be significantly different (AF 1.8%; non-AF 1.0%; p = 0.40). In conclusion, patients with AF had similar 1-year survival, MR reduction, and stroke incidence compared with non-AF patients. However, MitraClip patients with AF had reduced long-term survival and remained more symptomatic compared with those without AF.

• Authors: Juliëtte F Velu, Friso A Kortlandt, Tom Hendriks, Remco A J Schurer, Ad J van Boven, Karel T Koch, M Marije Vis, Jose P Henriques, Jan J Piek, Ben J L Van den Branden, Jeroen Schaap, Benno J Rensing, Martin J Swaans, Berto J Bouma, Jan A S Van der Heyden, Jan Baan Jr
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 120 Issue 11 Pg. 2035-2040 (Dec 01 2017) ISSN: 1879-1913 [Electronic] United States
• PMID: 29033048 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Atrial Fibrillation (complications, mortality, physiopathology)
• Echocardiography, Transesophageal
• Electrocardiography
• Female
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (methods)
• Humans
• Incidence
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Mitral Valve (diagnostic imaging, surgery)
• Mitral Valve Insufficiency (complications, mortality, surgery)
• Netherlands (epidemiology)
• Postoperative Complications (epidemiology)
• Prosthesis Design
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome
• Ventricular Function, Left (physiology)