Impact of sex on outcomes after percutaneous repair of functional mitral valve regurgitation.
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
17
01
2021
accepted:
07
02
2021
pubmed:
23
2
2021
medline:
20
5
2021
entrez:
22
2
2021
Statut:
ppublish
Résumé
The role of percutaneous repair of functional mitral regurgitation (MR) is evolving. Left ventricle remodeling is known to be different between men and women; however, outcomes following percutaneous repair of functional MR have not considered the impact of sex. Between 2012 and 2018, 175 patients underwent percutaneous repair of functional MR with the Mitra Clip NT/NTR (Abbott) at our institution. Patients were assessed in a dedicated clinic with a follow-up that averaged 0.7 ± 1.2 years and extended to 5.7 years. Men had a larger body surface area than women (p < .001), and were more likely than women to have diabetes preoperatively (p = .02). There were no deaths or instances of single leaflet detachment. Immediate postprocedure MR was ≤2+ in 158 (90%) with a mean trans-mitral valve repair gradient of 3.4 ± 1.0 and 3.5 ± 2.1 mmHg, respectively for women and men (p = .8). One- and 2-year freedom from MR ≥3+ was 86.0 ± 3.5% and 77.6 ± 5.1%, respectively. After adjusting for differences between male and female patients, women were more likely to have recurrent MR ≥3+ (hazard ratio, 4.7; 95% confidence interval, 1.2-18.4; p = .03). Upon adjusted analysis, there was also no association between gender and survival (p = .2). One- and 2-year survival was 69.8 ± 4.3% and 54.3 ± 5.5%, respectively. Women are more likely to have recurrent severe MR after percutaneous repair of functional MR. The mechanism for this remains undetermined.
Sections du résumé
BACKGROUND
BACKGROUND
The role of percutaneous repair of functional mitral regurgitation (MR) is evolving. Left ventricle remodeling is known to be different between men and women; however, outcomes following percutaneous repair of functional MR have not considered the impact of sex.
METHODS
METHODS
Between 2012 and 2018, 175 patients underwent percutaneous repair of functional MR with the Mitra Clip NT/NTR (Abbott) at our institution. Patients were assessed in a dedicated clinic with a follow-up that averaged 0.7 ± 1.2 years and extended to 5.7 years.
RESULTS
RESULTS
Men had a larger body surface area than women (p < .001), and were more likely than women to have diabetes preoperatively (p = .02). There were no deaths or instances of single leaflet detachment. Immediate postprocedure MR was ≤2+ in 158 (90%) with a mean trans-mitral valve repair gradient of 3.4 ± 1.0 and 3.5 ± 2.1 mmHg, respectively for women and men (p = .8). One- and 2-year freedom from MR ≥3+ was 86.0 ± 3.5% and 77.6 ± 5.1%, respectively. After adjusting for differences between male and female patients, women were more likely to have recurrent MR ≥3+ (hazard ratio, 4.7; 95% confidence interval, 1.2-18.4; p = .03). Upon adjusted analysis, there was also no association between gender and survival (p = .2). One- and 2-year survival was 69.8 ± 4.3% and 54.3 ± 5.5%, respectively.
CONCLUSION
CONCLUSIONS
Women are more likely to have recurrent severe MR after percutaneous repair of functional MR. The mechanism for this remains undetermined.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1900-1903Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Aronson D. Ishemic mitral regurgitation and risk of heart failure after myocardial infarction. Arch Intern Med. 2006;166:2362-2368.
Perez de Isla L, Zamorano J, Quezada M, et al. Prognostic significance of functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome. Eur Heart J. 2006;27:2655-2660.
Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159-e1195.
Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379(24):2307-2318.
Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018;379(24):2297-2306.
Grayburn PA, Sannino A, Packer M. Proportionate and disproportionate functional mitral regurgitation: a new conceptual framework that reconciles the results of the MITRA-FR and COAPT Trials. JACC Cardiovasc Imaging. 2019;12(2):353-362.
Lloyd-Jones DM, Larson MG, Leip EP, et al. Lifetime risk for developing congestive heart failure: the Framingham heart study. Circulation. 2002;106:3068-3072.
Shaw LJ, Bugiardini R, Merz CN. Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol. 2009;54:1561-1575.
Jochmann N, Stangl K, Garbe E, Baumann G, Stangl V. Female-specific aspects in the pharmacotherapy of chronic cardiovascular diseases. Eur Heart J. 2005;26:1585-1595.
Chan V, Chen L, Elmistekawy E, Ruel M, Mesana TG. Determinants of late outcomes in women undergoing mitral repair of myxomatous degeneration. Interact Cardiovasc Thorac Surg. 2016;23(5):779-783.
Chan V, Chen L, Messika-Zeitoun D, Elmistekawy E, Ruel M, Mesana T. Is late left ventricle remodeling after repair of degenerative mitral regurgitation worse in women? Ann Thorac Surg. 2019;108(4):1189-1193.
Johnston A, Mesana TG, Lee DS, Eddeen AB, Sun LY. Sex differences in long-term survival after major cardiac surgery: a population-based cohort study. J Am Heart Assoc. 2019;8(17):e013260.
Stone GW, Adams DH, Abraham WT, et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: a consensus document from the Mitral Valve Academic Research Consortium. Eur Heart J. 2015;36(29):1878-1891.
Tigges E, Kalbacher D, Thomas C, et al. Transcatheter mitral valve repair in surgical high-risk patients: gender-specific acute and long-term outcomes. BioMed Res Int. 2016;2016. https://doi.org/10.1155/2016/3934842
Werner N, Puls M, Baldus S, et al. German Transcatheter Mitral Valve Intervention (TRAMI) investigators. Gender-related differences in patients undergoing transcatheter mitral valve interventions in clinical practice: 1-year results from the German TRAMI registry. Catheter Cardiovasc Interv. 2020;95(4):819-829. https://doi.org/10.1002/ccd.28372
Gafoor S, Sievert H, Maisano F, et al. Gender in the ACCESS-EU registry: a prospective, multicentre, non-randomised post-market approval study of MitraClip therapy in Europe. EuroIntervention. 2016;12(2):e257-e264.
Attizzani GF, Ohno Y, Capodanno D, et al. Gender-related clinical and echocardiographic outcomes at 30-day and 12-month follow up after MitraClip implantation in the GRASP registry. Catheter Cardiovasc Interv. 2015;85(5):889-897.
Kar S, Feldman T, Qasim A, et al. Five-year outcomes of transcatheter reduction of significant mitral regurgitation in high-surgical-risk patients. Heart. 2019;105(21):1622-1628.
Ailawadi G, Lim DS, Mack MJ, et al. One-year outcomes after MitraClip for functional mitral regurgitation. Circulation. 2019;139(1):37-47.
Abbott. Abbott receives US approval of next generation MitraClip. 2019. https://abbott.mediaroom.com/-07-15-Abbott-Receives-U-S-Approval-of-Next-Generation-MitraClip-R-Bringing-New-Enhancements-to-Abbotts-Leading-MitraClip-Platform. Accessed December 23, 2019.