2012•The Thoracic and Cardiovascular SurgeonRequires access
Treatment of functional mitral regurgitation – Intervention or surgery?
Lenard Conradi, Paul Graumüller, Hendrick Treede, Moritz Seiffert, Stephan Ernst Baldus, Volker Rudolph, Johannes M. Schirmer, FM Wagner, Stefan Blankenberg, Hermann C. Reichenspurner
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Abstract
Objectives: Corrective surgery for functional mitral regurgitation (FMR) by restrictive annuloplasty has proven beneficial in that it improves NYHA functional class and induces reverse remodeling. However, proof of a survival benefit for such patients is still pending. Percutaneous techniques of mitral valve repair (MVR) may become a viable treatment alternative for high-risk patients with severe FMR. Methods: We retrospectively analyzed our prospective hospital database of patients with severe FMR undergoing either surgical MVR or percutaneous treatment using the MitraClip™ device. Patient characteristics and 6 months outcomes are reported. Results: From March 2002 through June 2010 76 patients underwent isolated surgical MVR for FMR while 69 patients were treated using the MitraClip™ device. Patients undergoing MitraClip™ treatment were significantly older (73.0 vs. 64.5 years, p<0.0001), had a lower left ventricular ejection fraction (37.0% vs. 40.4%, p=0.15), and were generally more high-risk with significantly higher mean EuroSCOREs compared to surgical candidates (33.0% vs. 10.3%, p<0.0001). Mortality was 5.9% and 3.3% at 30 days, and 11.8 and 4.8% at 6 months (p=0.16) for intervention and surgery respectively. Freedom from MR ≤ II at 180 days was 94.7% after MVR and 76.8% after MitraClip™ therapy (p=0.007). Conclusions: In our experience, characteristics and risk factors of patients with severe FMR undergoing surgery differ significantly from those considered for interventional therapy. At 6 months, surgery is more effective compared to MitraClip™ in reducing MR. However, a large proportion of patients benefits from intervention with sustained MR ≤ II. Especially for elderly patients with reduced left ventricular function and relevant comorbidities, MitraClip™ therapy seems an adequate alternative to surgery. Assessment, treatment and postprocedural care of patients by an interdisciplinary team is of paramount importance for clinical success.