The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Leaflet edge-to-edge treatment versus direct annuloplasty in patients for functional mitral regurgitation

DOI: 10.4244/EIJ-D-19-00468

1. Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany, GERMANY
2. Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany
3. Department of Cardiac and Vascular Surgery, University Hospital Zurich, Switzerland
4. Department of Cardiac and Vascular Surgery, University Hospital Zurich, Switzerland
5. Heart Center, University of Cologne, Germany
6. Heart Center, University of Cologne, Germany
7. Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
8. Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy
9. Ospedale San Raffaele, Milan, Italy
10. Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
11. Department of Cardiac and Vascular Surgery, University Hospital Zurich, Switzerland
12. Heart Center, University of Cologne, Germany
13. Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany
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Aims:Interventional mitral repair techniques have evolved as safe and effective treatment options for patients with functional mitral regurgitation (FMR) at high or prohibitive surgical risk. Of the techniques available, the MitraClip device and Cardioband mitral repair system have been used most commonly. However, a direct comparison of the two devices, examining their effectiveness at reducing MR, reducing symptoms, and extending life expectancy, has not yet been performed.

Methods and results:We collected 123 consecutive patients that were treated with the Cardioband device and 455 consecutive patients treated with the MitraClip from five experienced European centers. Propensity score matching was performed, resulting in two groups with 93 patients each – with no significant differences regarding baseline demographic parameters – who underwent standardized 2D transthoracic echocardiography with assessment at baseline and clinical follow-up at 12 months. The success rate, defined as a reduction of MR to grade 2 or lower, was high in both groups (MR ≤2: MitraClip: 86%, Cardioband: 77%, p=0.18). The Cardioband was better at reducing heart failure symptoms (NYHA ≤2; 88%) than the MitraClip (75%) procedure (p=0.046) at 12-months follow-up. All-cause rehospitalization and mortality within 12 months were lower in Cardioband patients (mortality: OR 0.30, CI 0.09-0.98, p=0.032; rehospitalization: OR 0.57, CI: 0.28-0.97, p= 0.03).

Conclusions:The MitraClip and the Cardioband procedures effectively reduce MR and heart failure symptoms. However, patients undergoing the Cardioband procedure showed a more pronounced improvement with regard to functional NYHA class, rehospitalization, and mortality, compared to patients undergoing the MitraClip procedure.

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