Clinical outcomes and predictors in patients with previous cardiac surgery undergoing mitral valve transcatheter edge-to-edge repair

Francesco De Felice; Luca Paolucci; Carmine Musto; Alberta Cifarelli; Carmelo Grasso; Corrado Tamburino; Marianna Adamo; Paolo Denti; Arturo Giordano; Antonio L Bartorelli; Matteo Montorfano; Rodolfo Citro; Annalisa Mongiardo; Ida Monteforte; Diego Maffeo; Cristina Giannini; Gabriele Crimi; Giuseppe Tarantini; Antonio P Rubbio; Francesco Bedogni

doi:10.1002/ccd.30245

Clinical outcomes and predictors in patients with previous cardiac surgery undergoing mitral valve transcatheter edge-to-edge repair

Catheter Cardiovasc Interv. 2022 Sep;100(3):451-460. doi: 10.1002/ccd.30245. Epub 2022 May 29.

Authors

Francesco De Felice¹, Luca Paolucci¹, Carmine Musto¹, Alberta Cifarelli¹, Carmelo Grasso², Corrado Tamburino², Marianna Adamo³, Paolo Denti⁴, Arturo Giordano⁵, Antonio L Bartorelli^{6

7}, Matteo Montorfano⁸, Rodolfo Citro⁹, Annalisa Mongiardo¹⁰, Ida Monteforte¹¹, Diego Maffeo¹², Cristina Giannini¹³, Gabriele Crimi¹⁴, Giuseppe Tarantini¹⁵, Antonio P Rubbio¹⁶, Francesco Bedogni¹⁶

Affiliations

¹ Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy.
² Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
³ Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy.
⁴ Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
⁵ Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.
⁶ Interventional Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
⁷ Department of Biomedical and Clinical Sciences, "Luigi Sacco," University of Milan, Milan, Italy.
⁸ Cardio-Thoracic-Vascular Department, IRCSS San Raffaele Scientific Institute, Milan, Italy.
⁹ Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
¹⁰ Division of Cardiology, University Magna Graecia, Catanzaro, Italy.
¹¹ Interventional Cardiology Department, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy.
¹² Interventional Cardiology Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
¹³ Cardiothoracic and Vascular Department, Cardiac Catheterization Laboratory, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
¹⁴ Interventional Cardiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁵ Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy.
¹⁶ Department of Cardiology, IRCCS Policlinico San Donato, Milan, San Donato Milanese, Italy.

PMID: 35644994
DOI: 10.1002/ccd.30245

Abstract

Background: Mitral-valve transcatheter edge-to-edge repair (MV-TEER) is recommended in patients with severe functional mitral regurgitation (FMR) and in those with degenerative mitral regurgitation (DMR) not eligible to traditional surgery. Patients with a history of previous cardiac surgery are considered at high risk for surgical reintervention, but data are lacking regarding procedural and clinical outcomes.

Objective: aim of this study was to assess the efficacy and clinical results of MV-TEER in patients with previous cardiac surgery enrolled in the "multicentre Italian Society of Interventional Cardiology registry of transcatheter treatment of mitral valve regurgitation" (GIOTTO).

Methods: Patients with previous coronary artery bypass grafting (CABG), surgical aortic valve replacement (AVR), or mitral valve repair (MVR) were included. Those with multiple or combined previous cardiac surgeries were excluded. Clinical follow-up was performed at 30 days, 1 year, and 2 years. The primary endpoint was a composite of death or rehospitalization at 1- and 2-year follow-ups.

Results: A total of 330 patients enrolled in the GIOTTO registry were considered (CABG 77.9%, AVR 14.2%, and MVR 7.9%). Most patients showed FMR (66.9%), moderate reduction of left ventricular (LV) ejection fraction, and signs of LV dilation. Procedural and device successes were 94.8% and 97%. At 1 and 2 years, the composite endpoint occurred are 29.1% and 52.4%, respectively. The composite outcome rates were similar across the three subgroups of previous cardiac surgery (p = 0.928) and between the FMR and DMR subgroups (p = 0.850) at 2 years. In a multivariate analysis, residual mitral regurgitation (rMR) ≥2+ was the main predictor of adverse events at 1 year (hazard ratio: 1.54 [95% confidence interval, CI: 1.00-2.38]; p = 0.050). This association was confirmed at 2 years of Kaplan-Meier analysis (p = 0.001).

Conclusions: MV-TEER is effective in these patients, regardless of the subtype of previous cardiac surgery and the MR etiology. An rMR ≥2+ is independently associated with adverse outcomes at 1-year follow-up.

Keywords: MV-TEER; MitraClip; mitral regurgitation.

MeSH terms

Cardiac Catheterization
Cardiac Surgical Procedures* / adverse effects
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis Implantation* / methods
Humans
Mitral Valve / diagnostic imaging
Mitral Valve / surgery
Mitral Valve Insufficiency* / diagnostic imaging
Mitral Valve Insufficiency* / etiology
Mitral Valve Insufficiency* / surgery
Treatment Outcome