MitraClip for radiotherapy-related mitral valve regurgitation
Objective: Owing to mediastinal and cardiac damage burden, the surgical treatment of radiotherapy-related mitral regurgitation (MR) may be associated with high operative risk or might even contraindicated. We evaluated the feasibility and outcome of MitraClip therapy in patients with radiotherapy-re...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-07-01
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| Series: | Hellenic Journal of Cardiology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1109966618302379 |
| _version_ | 1818015916367020032 |
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| author | Iside Scarfò Paolo Denti Rodolfo Citro Nicola Buzzatti Ottavio Alfieri Giovanni La Canna |
| author_facet | Iside Scarfò Paolo Denti Rodolfo Citro Nicola Buzzatti Ottavio Alfieri Giovanni La Canna |
| author_sort | Iside Scarfò |
| collection | DOAJ |
| description | Objective: Owing to mediastinal and cardiac damage burden, the surgical treatment of radiotherapy-related mitral regurgitation (MR) may be associated with high operative risk or might even contraindicated. We evaluated the feasibility and outcome of MitraClip therapy in patients with radiotherapy-related MR as an alternative to surgery. Methods: Based on Doppler Echocardiography, 15 of 33 screened patients underwent MitraClip implantation. Results: Following MitraClip MR improved (residual MR ≤2+) without significant mitral valve stenosis (planimetric area 2.83 ± 0.8 cm2, mean gradient 4.6 ± 1.8 mm Hg). All patients completed a 6-month follow-up, while 14 of 15 patients achieved a longer follow-up, ranging from 12 to 72 months (median 24 months, IQR 42 months). At 6-month follow-up we observed NYHA improvement in 13 patients with an increase of 6-min walking covered distance (from 260 ± 34 to 367 ± 70, p < 0.001), sustained moderate or less MR, mild mitral stenosis in 3 patients, and significant systolic Pulmonary Artery Pressure (PAPs) reduction (from 52.5 ± 14 to 42 ± 9, p < 0.01). Sustained clinical improvement and ≤2+ MR was observed in 13 of 14 patients who completed the 12-month follow-up. Two patients died of acute pneumonia (11 months and 60 months, respectively). One patient developed moderate MV stenosis (MVA 1.4 cm2) at last follow-up (48 months) without related clinical instability. Tricuspid regurgitation improved in 12 patients with further improvement at late follow-up in 2 of 3 patient with 3+. Conclusion: MitraClip may be an effective treatment for RT-induced MR, although unexpected late stenosis may occur in the context of sustained reactive mitral apparatus damage following mediastinal radiation. Keywords: MitraClip, Radiotherapy, Mitral valve regurgitation |
| first_indexed | 2024-04-14T07:04:40Z |
| format | Article |
| id | doaj.art-4f6d5214383e41d6965a2110984c04bd |
| institution | Directory Open Access Journal |
| issn | 1109-9666 |
| language | English |
| last_indexed | 2024-04-14T07:04:40Z |
| publishDate | 2019-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hellenic Journal of Cardiology |
| spelling | doaj.art-4f6d5214383e41d6965a2110984c04bd2022-12-22T02:06:36ZengElsevierHellenic Journal of Cardiology1109-96662019-07-01604232238MitraClip for radiotherapy-related mitral valve regurgitationIside Scarfò0Paolo Denti1Rodolfo Citro2Nicola Buzzatti3Ottavio Alfieri4Giovanni La Canna5Echocardiography Unit and Cardiac Surgery Department, Scientific Institute San Raffaele, Milan, ItalyEchocardiography Unit and Cardiac Surgery Department, Scientific Institute San Raffaele, Milan, ItalyHeart Department, University Hospital, “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, ItalyEchocardiography Unit and Cardiac Surgery Department, Scientific Institute San Raffaele, Milan, ItalyEchocardiography Unit and Cardiac Surgery Department, Scientific Institute San Raffaele, Milan, ItalyEchocardiography Unit and Cardiac Surgery Department, Scientific Institute San Raffaele, Milan, Italy; Corresponding author. Giovanni La Canna, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. Tel. 00393356744319.Objective: Owing to mediastinal and cardiac damage burden, the surgical treatment of radiotherapy-related mitral regurgitation (MR) may be associated with high operative risk or might even contraindicated. We evaluated the feasibility and outcome of MitraClip therapy in patients with radiotherapy-related MR as an alternative to surgery. Methods: Based on Doppler Echocardiography, 15 of 33 screened patients underwent MitraClip implantation. Results: Following MitraClip MR improved (residual MR ≤2+) without significant mitral valve stenosis (planimetric area 2.83 ± 0.8 cm2, mean gradient 4.6 ± 1.8 mm Hg). All patients completed a 6-month follow-up, while 14 of 15 patients achieved a longer follow-up, ranging from 12 to 72 months (median 24 months, IQR 42 months). At 6-month follow-up we observed NYHA improvement in 13 patients with an increase of 6-min walking covered distance (from 260 ± 34 to 367 ± 70, p < 0.001), sustained moderate or less MR, mild mitral stenosis in 3 patients, and significant systolic Pulmonary Artery Pressure (PAPs) reduction (from 52.5 ± 14 to 42 ± 9, p < 0.01). Sustained clinical improvement and ≤2+ MR was observed in 13 of 14 patients who completed the 12-month follow-up. Two patients died of acute pneumonia (11 months and 60 months, respectively). One patient developed moderate MV stenosis (MVA 1.4 cm2) at last follow-up (48 months) without related clinical instability. Tricuspid regurgitation improved in 12 patients with further improvement at late follow-up in 2 of 3 patient with 3+. Conclusion: MitraClip may be an effective treatment for RT-induced MR, although unexpected late stenosis may occur in the context of sustained reactive mitral apparatus damage following mediastinal radiation. Keywords: MitraClip, Radiotherapy, Mitral valve regurgitationhttp://www.sciencedirect.com/science/article/pii/S1109966618302379 |
| spellingShingle | Iside Scarfò Paolo Denti Rodolfo Citro Nicola Buzzatti Ottavio Alfieri Giovanni La Canna MitraClip for radiotherapy-related mitral valve regurgitation Hellenic Journal of Cardiology |
| title | MitraClip for radiotherapy-related mitral valve regurgitation |
| title_full | MitraClip for radiotherapy-related mitral valve regurgitation |
| title_fullStr | MitraClip for radiotherapy-related mitral valve regurgitation |
| title_full_unstemmed | MitraClip for radiotherapy-related mitral valve regurgitation |
| title_short | MitraClip for radiotherapy-related mitral valve regurgitation |
| title_sort | mitraclip for radiotherapy related mitral valve regurgitation |
| url | http://www.sciencedirect.com/science/article/pii/S1109966618302379 |
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