Chronic obstructive pulmonary disease (COPD) and cardiovascular disease are associated to hospitalization and mortality.
When associated to severe mitral regurgitation, not only do these two conditions have poor evolution, but they also limit the possibility of surgical valve replacement, given its high risk. Edge-to-edge repair with MitraClip has been shown beneficial in a group of patients, but the information is quite limited. Only a few reports, such as the COAPT, have looked at data from this population.
The study looked at 340 patients with severe mitral regurgitation undergoing edge to edge repair with MitraClip. 82 presented COPD (24.1%) defined by pulmonary function tests and GOLD criteria.
From COPD patients, 26 showed GOLD stage 3 or 4 and the rest 2.
The groups were similar. Patients who did not present COPD were older. The ratio of men was higher in the COPD group. There were no differences in comorbidities.
25% presented primary mitral valve disease, ejection fraction was 40%, ORE was 36 mm2 with no differences in echocardiographic values.
Procedural success was similar for both groups: COPD 97.4% vs. non-COPD 94.6% (p=0.27). Neither were there differences in mortality (4.9% vs. 5% p=0.95). In addition, mortality was similar between the GOLD COPD 3-4 vs non-COPD.
AT 30-day follow up, there were no differences in mortality, but there was a trend towards higher rehospitalization rate among COPD patients (12.9% vs. 6.8%, p = 0.08).
At one year, there were no differences in mortality, but the was a trend towards increased one year mortality among COPD patients (31.2% vs. 20.6%, p = 0.06). There were no differences in rehospitalization for cardiac failure and both groups improved functional class, with no difference between them.
There were no differences in the combined end point of mortality and rehospitalization for cardiac failure.
Doppler echocardiogram at one year showed no differences in the presence of moderate or severe mitral regurgitation.
Conclusion
COPD is highly prevalent among patients undergoing edge-to-edge for mitral valve repair. This strategy seems safe and effective in this group. COPD severity and impaired pulmonary function alone should not be considered a contraindication for edge-to-edge mitral valve repair.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Original: Safety and efficacy of transcatheter mitral valve repair in patients with COPD; results from real‐world cohort.
Reference: Mhd Nawar Alachkar, et al. Catheter Cardiovasc Interv. 2022;100:145–153.
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