Percutaneous mitral valve repair safe, effective in frail patients

Patients classified as frail who undergo percutaneous mitral valve repair (PMVR) demonstrate greater short-term improvement in quality of life than their nonfrail counterparts and similar improvements in six-minute walking distance and functional status, a new study found.

Researchers at the University of Cologne in Germany studied 213 PMVR patients, 45.5 percent of whom were classified as frail, and assessed six-week outcomes and long-term outcomes with a median follow-up of 429 days. All patients—mean age 78; 57.3 percent men—received the catheter-based MitraClip system from Abbott Vascular.

Frail patients demonstrated a threefold increased risk of death over the long-term follow-up and a doubled risk of death or hospitalization due to heart failure. However, those results weren’t surprising considering that group was older on average, had significantly worse renal function and worse functional status at baseline.

The greater clinical implication of the study, according to the researchers, is the procedure proved equally safe in frail patients and allowed for functional and quality-of-life improvements in a population typically deemed too high-risk for surgery. There was a 96.7 percent procedural success rate across the entire study cohort.

“Although frail patients are more likely to die after MitraClip implantation compared with nonfrail patients, our data demonstrate that frailty does not affect the procedural success and safety of MitraClip implantation and that frail patients derive at least as much benefit in functional status and quality of life as nonfrail patients,” wrote lead researcher Clemens Metze, from the department of internal medicine at the University of Cologne, and colleagues in JACC: Cardiovascular Interventions. “These results support the continued use of the MitraClip in frail elderly patients, in whom the goal is palliation of heart failure symptoms and improvement in quality of life.”

Patients were classified as frail if they met at least three of five criteria: unintentional weight loss, weak grip strength, self-reported exhaustion, slow walking and low physical activity.