Transcatheter edge-to-edge repair for secondary mitral regurgitation with third-generation devices in heart failure patients - results from the Global EXPAND Post-Market study.

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Citation: European Journal of Heart Failure. 25(3):411-421, 2023 03.PMID: 36597850Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Heart Failure | *Heart Valve Prosthesis Implantation | *Mitral Valve Insufficiency | Aged | Aged, 80 and over | Cardiac Catheterization | Female | Heart Valve Prosthesis Implantation/mt [Methods] | Humans | Male | Middle Aged | Mitral Valve Insufficiency/su [Surgery] | Mitral Valve/dg [Diagnostic Imaging] | Mitral Valve/su [Surgery] | Prospective Studies | Treatment Outcome | Year: 2023ISSN:
  • 1388-9842
Name of journal: European journal of heart failureAbstract: AIMS: Mitral valve transcatheter edge-to-edge repair is a guideline-recommended treatment option for patients with secondary mitral regurgitation (SMR). The purpose of this analysis was to report contemporary real-world outcomes in SMR patients treated with third-generation MitraClip systems.CONCLUSIONS: Under real-world conditions, optimal sustained MR reduction to MR <= 1+ was achieved in a high percentage of patients with third-generation MitraClip, which translated into symptomatic improvement and low event rates. These results appear to be comparable with recent randomized clinical trials. Copyright � 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.METHODS AND RESULTS: EXPAND is a prospective, multicentre, international, single-arm study with 1041 patients treated for mitral regurgitation (MR) with MitraClip NTR/XTR, with 30-day and 1-year follow-up. All echocardiograms were analysed by an independent echocardiographic core lab. Study outcomes included procedural outcomes, durability of MR reduction, and major adverse events including all-cause mortality and heart failure hospitalizations (HFH). A subgroup of 413 symptomatic patients (age 74.7 +/- 10.1 years, 58% male) with severe SMR were included. MR reduction to MR <= 1+ and MR <= 2+ was achieved in 93.0% and 98.5% of patients, respectively, which was sustained at 1-year follow-up. All-cause mortality was 17.7% at 1-year- follow-up, and the combined endpoint of all-cause mortality or first HFH occurred in 34% of patients. This combined endpoint was significantly less frequently observed in MR <= 1+ patients (Kaplan-Maier estimates: 29.7% vs. 69.6% for MR <= 1+ vs. MR >= 2 +; p < 0.0001). New York Heart Association (NYHA) functional class improved significantly from baseline (NYHA <= II: 17%) to 1-year follow-up (NYHA <= II: 78%) (p < 0.0001). While MR reduction was comparable between NTR-only vs. XTR-only treated patients, less XTR clips were required for achieving MR reduction.All authors: Orban MOriginally published: European Journal of Heart Failure. 2023 Jan 04Original year of publication: 2023Fiscal year: FY2023Fiscal year of original publication: | FY2023 | | | Original title: Transcatheter edge-to-edge repair for secondary mitral regurgitation with third-generation devices in heart failure patients - results from the Global EXPAND Post-Market study.Digital Object Identifier: Date added to catalog:
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AIMS: Mitral valve transcatheter edge-to-edge repair is a guideline-recommended treatment option for patients with secondary mitral regurgitation (SMR). The purpose of this analysis was to report contemporary real-world outcomes in SMR patients treated with third-generation MitraClip systems.

CONCLUSIONS: Under real-world conditions, optimal sustained MR reduction to MR <= 1+ was achieved in a high percentage of patients with third-generation MitraClip, which translated into symptomatic improvement and low event rates. These results appear to be comparable with recent randomized clinical trials. Copyright � 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

METHODS AND RESULTS: EXPAND is a prospective, multicentre, international, single-arm study with 1041 patients treated for mitral regurgitation (MR) with MitraClip NTR/XTR, with 30-day and 1-year follow-up. All echocardiograms were analysed by an independent echocardiographic core lab. Study outcomes included procedural outcomes, durability of MR reduction, and major adverse events including all-cause mortality and heart failure hospitalizations (HFH). A subgroup of 413 symptomatic patients (age 74.7 +/- 10.1 years, 58% male) with severe SMR were included. MR reduction to MR <= 1+ and MR <= 2+ was achieved in 93.0% and 98.5% of patients, respectively, which was sustained at 1-year follow-up. All-cause mortality was 17.7% at 1-year- follow-up, and the combined endpoint of all-cause mortality or first HFH occurred in 34% of patients. This combined endpoint was significantly less frequently observed in MR <= 1+ patients (Kaplan-Maier estimates: 29.7% vs. 69.6% for MR <= 1+ vs. MR >= 2 +; p < 0.0001). New York Heart Association (NYHA) functional class improved significantly from baseline (NYHA <= II: 17%) to 1-year follow-up (NYHA <= II: 78%) (p < 0.0001). While MR reduction was comparable between NTR-only vs. XTR-only treated patients, less XTR clips were required for achieving MR reduction.

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