Taams, G.J. (Gerrit-Jan) (2016) Onderzoek naar Linker Ventrikel Ejectie Fractie als Voorspeller voor Mortaliteit na MitraClip-procedure : Resultaten en voorspellende factoren van het Medisch centrum Leeuwarden. thesis, Medicine.
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Abstract
Background and objective: Transcatheter mitral valve repair using the edge-to-edge technique (only MitraClip is currently approved) has become an important therapeutic option for the treatment of mitral valve regurgitation (MR) in patients with a prohibitive surgical risk. Transcatheter interventions for valvular heart disease are expected to grow. Despite growing evidence supporting the efficiency and safety of MitraClip therapy, data on predicting factors for the outcomes after the procedure is still limited. To improve the outcome of the procedure, patiënt selection is necessary for which predictive factors are required. The main aim of this study was to find pre-procedural factors that predict cardiac mortality after MitraClip therapy. The factor of main interest in this study was left ventricular ejection fraction (LVEF). Methods and Results: The MitraClip-Leeuwarden study was a retrospective cohort study with data collection of 68 patients, of which 71 % had functional MR and 67 patients were in New York Heart Association functional class III-IV, that underwent MitraClip therapy between November 2011 and August 2015. Baseline factors were tested for predictive value for the primary endpoint cardiac death. LVEF was not predictive for cardiac mortality: neither as a continuous variable HR 0,99 (CI 0,96-1,021 p=0,506) nor when grouped with a cut-off point of LVEF<30%: HR 2,00 (CI 0,81-4,91 p=0,135). In this study, however, several other preprocedural predictors for cardiac mortality after MitraClip procedures were identified: reduced right ventricular ejection fraction (RVEF) (continuous variable and RVEF<25%), euroscore II, the presence of an internal cardiac resynchronisation therapy (CRT) or cardiac defibrilator (ICD), left ventricular dilatation, peripheral artery disease and smoking. Conclusion: MitraClip therapy is feasible in patients with severely reduced LVEF. Possession of ICD or CRT, raised Euroscore II, left ventricular dilatation, reduced right ventricular function, peripheral artery disease and smoking proved predictive for cardiac mortality
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair Begeleider and Kappelle, dr. J. W. Internist and Afdeling Interne Geneeskunde, Medisch Centrum Leeuwarden |
| Supervisor name: | onder begeleiding van: and Boven, dr. A.J. Van and interventie-Cardioloog and Afdeling Cardiologie, Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/171 |
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