2-year outcomes of MitraClip as a bridge to heart transplantation: The international MitraBridge registry.

Munafò, Andrea Raffaele; Scotti, Andrea; Estévez-Loureiro, Rodrigo; Adamo, Marianna; Hernàndez, Antonio Portolés; Peregrina, Estefanìa Fernàndez; Gutierrez, Lola; Taramasso, Maurizio; Fam, Neil P; Ho, Edwin C; Asgar, Anita; Vitrella, Giancarlo; Raineri, Claudia; Chizzola, Giuliano; Pezzola, Elisa; Le Ruz, Robin; Montalto, Claudio; Oreglia, Jacopo A; Fraccaro, Chiara; Giannini, Cristina; ... (2023). 2-year outcomes of MitraClip as a bridge to heart transplantation: The international MitraBridge registry. International journal of cardiology, 390, p. 131139. Elsevier 10.1016/j.ijcard.2023.131139

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BACKGROUND

In the first report from the MitraBridge registry, MitraClip as a bridge to heart transplantation (HTx) proved to be at 1-year an effective treatment strategy for 119 patients with advanced heart failure (HF) who were potential candidates for HTx. We aimed to determine if benefits of MitraClip procedure as a bridge-to-transplant persist up to 2-years.

METHODS

By the end of the enrollment period, a total of 153 advanced HF patients (median age 59 years, left ventricular ejection fraction 26.9 ± 7.7%) with significant secondary mitral regurgitation, who were potential candidates for HTx and were treated with MitraClip as a bridge-to-transplant strategy, were included in the MitraBridge registry. The primary endpoint was the 2-year composite adverse events rate of all-cause death, first hospitalization for HF, urgent HTx or LVAD implantation.

RESULTS

Procedural success was achieved in 89.5% of cases. Thirty-day mortality was 0%. At 2-year, Kaplan-Meier estimates of freedom from primary endpoint was 47%. Through 24 months, the annualized rate of HF rehospitalization per patient-year was 44%. After an overall median follow-up time of 26 (9-52) months, elective HTx was successfully performed in 30 cases (21%), 19 patients (13.5%) maintained or obtained the eligibility for transplant, and 32 patients (22.5%) no longer had an indication for HTx because of significant clinical improvement.

CONCLUSIONS

After 2-years of follow-up, the use of MitraClip as a bridge-to-transplant was confirmed as an effective strategy, allowing elective HTx or eligibility for transplant in one third of patients, and no more need for transplantation in 22.5% of cases.

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