Incidence and Predictors of Cerebrovascular Accidents in Patients Who Underwent Transcatheter Mitral Valve Repair With MitraClip

Transcatheter mitral edge-to-edge repair (TEER) with transcatheter devices has become a mainstay in the minimally invasive treatment of patients with severe mitral regurgitation at increased surgical risk. Despite its apparently favorable risk profile, there is uncertainty on the risk and features of cerebrovascular accidents (CVAs) early and long after transcatheter mitral valve repair. We aimed to appraise the incidence and predictors of CVA in patients who underwent TEER. We explicitly queried the data set of an ongoing multicenter prospective observational study dedicated to TEER with MitraClip (Abbott Vascular, Santa Clara, California). The incidence of CVAs after TEER was formally appraised, and we explored potential predictors of such events. Descriptive, bivariate, and diagnostic accuracy analyses were performed. Of 2,238 patients who underwent TEER, CVAs occurred in 33 patients (1.47% [95% confidence interval 1.02% to 2.06%]), including 6 (0.27% [0.10% to 0.58%]) in-hospital strokes and 27 events after discharge (0.99% [0.66% to 1.44%]), over a median follow-up of 14 months. Most CVAs were major ischemic strokes during and after the in-hospital phase. Overall, CVAs were more common in patients with atrial fibrillation (p = 0.018), renal dysfunction (p = 0.032), higher EuroSCORE II (p = 0.033), and, as expected, higher CHA2DS2-VASc score (p = 0.033), despite the limited prognostic accuracy of the score. Notably, the occurrence of CVA did not confer a significantly increased risk of long-term (p = 0.136) or cardiac death (p = 0.397). The incidence of CVA in patients who underwent TEER is low, with most events occurring after discharge and being associated with preexisting risk features. These findings, although reassuring on the safety of TEER, call for proactive antithrombotic therapy whenever CVA risk is increased before and after TEER.

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Journal
The American Journal of Cardiology
Published
2024-08-05
DOI
https://doi.org/10.1016/j.amjcard.2024.07.037
Citations
1
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
Field-Weighted Citation Impact
0.40

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article

Incidence and Predictors of Cerebrovascular Accidents in Patients Who Underwent Transcatheter Mitral Valve Repair With MitraClip

Alberto Morello, Salvatore A. Giordano, Giuseppe Tarantini, Antonio L. Bartorelli et al.
1 citations
The American Journal of Cardiology
Cardiac Valve Diseases and Treatments
0.40
article

Incidence and Predictors of Cerebrovascular Accidents in Patients Who Underwent Transcatheter Mitral Valve Repair With MitraClip

Alberto Morello, Salvatore A. Giordano, Giuseppe Tarantini, Antonio L. Bartorelli, Paolo Ferraro, Matteo Montorfano, Fausto Castriota, Antonio Popolo Rubbio, Paolo Denti, Corrado Tamburino, Michele Cimmino, Francesco De Felice, Nicola Corcione, Angelo Squeri, Annalisa Mongiardo, Francesco Bedogni, Giuseppe Biondi‐Zoccai, Luigi Fiocca, Filippo Finizio, Federico Ronco, Maurizio Ferrario, Martino Pepe, Francesco Giannini, Arturo Giordano, Emmanuel Villa, Michele Albanese, Francesco Maisano, Marianna Adamo
article en
1 citations

Abstract

Transcatheter mitral edge-to-edge repair (TEER) with transcatheter devices has become a mainstay in the minimally invasive treatment of patients with severe mitral regurgitation at increased surgical risk. Despite its apparently favorable risk profile, there is uncertainty on the risk and features of cerebrovascular accidents (CVAs) early and long after transcatheter mitral valve repair. We aimed to appraise the incidence and predictors of CVA in patients who underwent TEER. We explicitly queried the data set of an ongoing multicenter prospective observational study dedicated to TEER with MitraClip (Abbott Vascular, Santa Clara, California). The incidence of CVAs after TEER was formally appraised, and we explored potential predictors of such events. Descriptive, bivariate, and diagnostic accuracy analyses were performed. Of 2,238 patients who underwent TEER, CVAs occurred in 33 patients (1.47% [95% confidence interval 1.02% to 2.06%]), including 6 (0.27% [0.10% to 0.58%]) in-hospital strokes and 27 events after discharge (0.99% [0.66% to 1.44%]), over a median follow-up of 14 months. Most CVAs were major ischemic strokes during and after the in-hospital phase. Overall, CVAs were more common in patients with atrial fibrillation (p = 0.018), renal dysfunction (p = 0.032), higher EuroSCORE II (p = 0.033), and, as expected, higher CHA2DS2-VASc score (p = 0.033), despite the limited prognostic accuracy of the score. Notably, the occurrence of CVA did not confer a significantly increased risk of long-term (p = 0.136) or cardiac death (p = 0.397). The incidence of CVA in patients who underwent TEER is low, with most events occurring after discharge and being associated with preexisting risk features. These findings, although reassuring on the safety of TEER, call for proactive antithrombotic therapy whenever CVA risk is increased before and after TEER.

The American Journal of CardiologyVol. 228
University of Padua (IT), Vita-Salute San Raffaele University (IT), University of Milan (IT), Magna Graecia University (IT), University of Catania (IT), Azienda Ospedaliera San Camillo-Forlanini (IT), IRCCS Policlinico San Donato (IT), Maria Cecilia Hospital (IT), Istituto Clinico Sant'Ambrogio (IT), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Ospedale Papa Giovanni XXIII (IT), Villa Pineta Hospital (IT), Ospedale dell' Angelo (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco" (IT), University of Bari Aldo Moro (IT), University of Brescia (IT), Sapienza University of Rome (IT)
Abbott Vascular
Good health and well-being
Openalex Percentile: Top 34%
Cardiac Valve Diseases and Treatments
0.40
DOIOpen Access PDFOpenAlex
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