Association of tricuspid regurgitation with clinical and echocardiographic outcomes after percutaneous mitral valve repair with the MitraClip System: 30-day and 12-month follow-up from the GRASP Registry

作者：Ohno Yohei; Attizzani Guilherme F; Capodanno Davide; Cannata Stefano; Dipasqua Fabio; Imme Sebastiano; Barbanti Marco; Ministeri Margherita; Caggegi Anna; Pistritto Anna M; Chiaranda Marta; Ronsivalle Giuseppe; Giaquinta Sandra; Farruggio Silvia; Mangiafico Sarah; Scandura Salvatore; Tamburino Corrado; Capranzano Piera; Grasso Carmelo^*

来源：European Heart Journal-Cardiovascular Imaging, 2014, 15(11): 1246-1255.

DOI：10.1093/ehjci/jeu114

• Mitral regurgitation
• Percutaneous mitral valve repair
• Tricuspid regurgitation
• MitraClip

Aim The aim of this study was to evaluate the association of baseline tricuspid regurgitation (TR) on the outcomes after percutaneous mitral valve repair (PMVR) with the MitraClip system. %26lt;br%26gt;Methods and results Data from 146 consecutive patients with functional mitral regurgitation (MR) were obtained. Two different groups, dichotomized according to the degree of pre-procedural TR (moderate/severe, n = 47 and none/mild, n = 99), had their clinical and echocardiographic outcomes through 12-month compared. At 30-day, the primary safety endpoint was significantly higher inmoderate/severe TR compared with none/mild TR(10.6 vs. 2.0%, P = 0.035). Marked reduction in MR grades observed post-procedure were maintained through 12 months. Although NYHA functional class significantly improved in both groups compared with baseline, it was impaired in moderate/severeTRcompared with the none/mild TR group (NYHA %26gt; II at 30 day: 33.3 vs. 9.2%, P %26lt; 0.001; at 1 year: 38.5 vs. 12.3%, respectively, P = 0.006). Left ventricle reverse remodelling and ejection fraction improvement were revealed in both groups. The primary efficacy endpoint at 12-month determined by freedom from death, surgery for mitral valve dysfunction, or grade %26gt;= 3+MR was comparable between groups, but combined death and re-hospitalization for heart failure rates were higher in the moderate/severe TR group. Multivariable Cox regression analysis demonstrated that baseline moderate/severe TR and chronic kidney disease were independent predictors of this combined endpoint. %26lt;br%26gt;Conclusions Although PMVR with MitraClip led to improvement in MR, TR, and NYHA functional class in patients with baseline moderate/severe TR, the primary safety endpoint at 30-day was impaired, while moderate/severe TR independently predicted death and re-hospitalization for heart failure at 12-month.

• 出版日期2014-11