Transcatheter Mitral Valve Repair as Bridge Therapy to Heart Transplantation

Launched by SCIENTIFIC INSTITUTE SAN RAFFAELE · Mar 2, 2020

Keywords

ClinConnect Summary

Background: Heart transplantation (HTx) is the most effective therapeutic option for patients with advanced or end-stage chronic heart failure (HF). However, the increasing number of patients with refractory chronic HF and the declining willingness for organ donation, have resulted in expanded waiting lists and prolonged waiting times for patients listed for HTx. Furthermore, more than 60% of patients are transplanted in high-urgency status, leaving little chance for patients listed for less urgent transplantation. In order to improve the general conditions of these latter patients during t...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • patients with chronic end-stage HF \[New York Heart Association (NYHA) III or IV and/or left ventricular ejection fraction (LVEF) ≤35%\] and concomitant moderate-severe or severe MR being potential candidates for HTx.
• • patients on active HTx list (In list group, "pure bridge") with a low likelihood to receive a donation shortly (e.g. for body weight or blood group);
• • patients suitable for HTx, but that were still waiting for clinical decision (Bridge to decision, "BTD" group);
• • patients who could not be yet in list for HTx (Bridge to candidacy, "BTC" group) because of concomitant, potentially reversible, contraindications such as severe pulmonary hypertension, elevated pulmonary-vascular-resistance, unsatisfactory response to vasodilator challenge or other causes resulting in a prohibitive peri-procedural risk (as pre-transplant body mass index \[BMI\] \>35 kg/m2, severe renal dysfunction with creatinine clearance \<30 mL/min) and other reasons (current alcohol, tobacco or drug abuse, poor social support, non-residents)
• Exclusion Criteria:
• • patients with mitral valve anatomy not suitable for percutaneous mitral valve repair using the MitraClip device