P2582Impact of left circumflex coronary artery disease on outcomes after successful transcatheter mitral valve repair using the MitraClip for ischaemic functional mitral regurgitation

Abstract

Introduction: The extent of coronary artery disease (CAD) influences the development of ischaemic functional mitral regurgitation (I-FMR). We hypothesized that the type of culprit vessel affected results and outcomes of transcatheter mitral valve repair (TMVR) using the MitraClip®. Purpose: We sought to assess clinical predictors of adverse outcomes of TMVR in patients with I-FMR, focusing on the extent of CAD. Methods: Out of 314 patients with functional mitral regurgitation who underwent TMVR from September 2009 to August 2015, 154 patients with I-FMR were enrolled in this study, after excluding patients with non-ischaemic origin (n=126), procedural failure (MR >2+ at discharge; n=19), and missing completion of angiographic confirmation (n=15). We analyzed patient characteristics to elucidate predictors of the composite endpoint of repeat mitral valve intervention and allcause mortality. The prevalence of CAD in the 154 I-FMR patients was as follows: left anterior descending (LAD) n=129 (84%), left circumflex (LCX) n=79 (51%), right coronary artery (RCA) n=96 (62%). Results: Median follow-up of the overall cohort was 465 (IQR 222 - 942) days. There were 65 patients (42%) who reached one of the endpoints; repeat TMVR in 10, conversion to mitral valve surgery in 4, and death in 51. None of the endpoints were observed in the other 89 patients (58%) during follow-up. A comparison of patients with and without a documented endpoint revealed that the prevalence of diabetes (44 patients [68%] vs. 40 [45%], p=0.005) and of LCX CAD (41 patients [63%] vs. 38 [43%], p=0.012), as well as estimated glomerular filtration rate (eGFR; 49±20 vs. 57±19 ml/min/1.73m2, p=0.011) were significantly higher in those with a documented endpoint than in those without. The prevalence of LAD (54 patients [83%] vs. 75 [84%], p=0.84) and RCA CAD (39 patients [60%] vs. 57 [64%], p=0.61), number of culprit coronary vessels (p=0.57, 3-vessel disease; 21 patients [32%] vs. 24 [27%], 2-vessel disease; 27 patients [42%] vs. 35 [39%], and 1-vessel disease; 17 [26%] vs. 30 [34%]), left ventricular (LV) ejection fraction (31±11 vs. 32±12%, p=0.81), LV end-diastolic diameter (64±9 vs. 64±10 mm, p=0.88), and history of coronary artery bypass grafting (35 patients [54%] vs. 44 [49%], p=0.52) were similar in both groups. (Figure Presented) Conclusions: The prevalence of LCX disease was significantly higher in patients with adverse outcomes after successful TMVR with the MC than those without. Further investigation is mandated to verify our results.