Valvuloplastie mitrale percutanée par système MitraClip : expérience lausannoise


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A Master's thesis.
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Master (thesis) (master)
Valvuloplastie mitrale percutanée par système MitraClip : expérience lausannoise
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Université de Lausanne, Faculté de biologie et médecine
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Symptomatic mitral regurgitation patients have a poor prognosis unless treated by surgery. 49% of them
are ineligible for surgical treatment due to contraindications or judged at high surgical risk by an
interdisciplinary heart team and are left untreated. Percutaneous treatment with the MitraClip device
is an alternative option for selected patients and has been proven to be safe and effective. The aim of
this study is to describe our institution’s early results with implantation of the MitraClip and to compare
them with other registries.
A retrospective observational study was performed in the University Hospital of Lausanne. All patients
treated with MitraClip in our institution between December 2012 and August 2018 were included in the
study. Primary outcomes were all-cause mortality or unplanned hospitalization for heart failure at 2-
years and overall improvement in New York Heart Association functional class. Secondary outcomes
included reduction in mitral regurgitation grade, change in left ventricular ejection fraction,
periprocedural complications and adverse event within one month.
A total of 75 patients (72% men) underwent the Mitraclip implantation, mainly for functional mitral
regurgitation (57%) of grade 3+ or 4+ (97%) with mean left ventricular ejection fraction of 44% and New
York Heart Association functional class III or IV (73%). Acute device implantation was successful in 87%
of cases. Periprocedural complications occurred in 24% of patients (3 patients with ischemic stroke and
1 patient had a cardiac tamponade). At the time of discharge, there was an improvement in the New
York Heart Association functional class (p<0.0001) with 51% of reduction of at least one functional class
and 90% of patients had mitral regurgitation ≤ 2+ (p<0.0001). Left ventricular ejection fraction was not
significantly different than baseline (p=0.48). In the first month post-implantation follow-up,
complications occurred in 14% of patients (1 patient died at 11 days after a hemorrhagic stroke and 1
patient had an ischemic stroke). Within 2-year, all-cause mortality was 28% with 85% of non-cardiac
cause, 24% needed readmission for heart failure and 4.0% had a mitral valve surgery.
In the University Hospital of Lausanne, the MitraClip procedure for patients with mitral regurgitation
and at high surgical risk is a safe and effective alternative facilitating the reduction of mitral regurgitation
and improving functional capacity. Primary and secondary outcomes are similar to those observed in
other registries (ACCESS-EU study, TCVT registry and TRAMI registry).
Cardiologie, Valvulopathie, Valve mitrale, Valvuloplastie, Mitraclip
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03/09/2019 9:12
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08/09/2020 7:11
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