Tusa M, Popolo Rubbio A, Sisinni A, Borin A, Barletta M, Grasso C, Adamo M, Denti P, Giordano A, De Marco F, Bartorelli AL, Montorfano M, Godino C, Citro R, De Felice F, Mongiardo A, Monteforte I, Villa E, Petronio AS, Giannini C, Munafò AR, Crimi G, Tarantini G, Testa L, Tamburino C, Bedogni F; GIOTTO Registry. Prognostic Significance of Flail Mitral Leaflet in Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation. Am J Cardiol. 2023 Aug 1;200:178-187. doi: 10.1016/j.amjcard.2023.05.045. Epub 2023 Jun 16. PMID: 37331223.
\nDespite the growing experience with MitraClip in the broad spectrum of mitral regurgitation (MR), limited data are available regarding the independent prognostic role on survival of different mitral regurgitation etiology subtypes. We sought to evaluate the impact of flail leaflet etiology in a large series of patients with primary MR (PMR) who underwent MitraClip treatment. The study included 588 patients with significant PMR from the multicenter GIOTTO (Italian Society of Interventional Cardiology [GIse] registry Of Transcatheter treatment of mitral valve regurgitaTiOn), stratified into 2 groups according to MR etiology: flail+ (n = 300) and flail- (n = 288). The primary end point was a composite of cardiac death and first rehospitalization for heart failure (HF). To account for the baseline differences, patients were propensity score-matched 1:1. Flail leaflet etiology was present in about a half of the patients. Acute technical success was achieved in 98% of the overall cohort, with no significant differences between the study groups (p = 0.789). At the 2-year Kaplan-Meier analysis, the primary end point occurred in 13% of flail+ patients compared with 23% in flail- (p = 0.009). The flail+ group presented lower rates of both cardiac death and rehospitalization for HF, whereas a similar overall death rate was observed between the groups. A multivariate Cox regression analysis identified flail leaflet etiology as an independent predictor of favorable outcome in terms of the primary end point (hazard ratio 0.141, 95% confidence interval 0.049 to 0.401, p <0.001). After propensity score matching, flail+ patients had confirmed lower rates of cardiac mortality and rehospitalization for HF but similar rates of overall death. In conclusion, flail leaflet-related etiology was common in patients with PMR who underwent MitraClip treatment and was an independent predictor of midterm favorable clinical outcomes.
\nIRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Donato is a university and research hospital provided with the main clinical specialties particularly focused on the study and treatment of cardiac and great vessel diseases through a multidisciplinary approach and devoted to high quality professional training.
\r\nOur institute is a didactic center of the Università degli Studi di Milano and it hosts the Faculty of Medicine, the Faculty of Nursing Sciences and some postgraduate medical residency programs. Moreover, our hospital is a medical training center chosen by many foreign students and doctors.
\r\nIn 1988 was established the Cardiovascular Department “Edmondo Malan” comprehensive of every medical and surgical cardiovascular specialties; since then, patients from every region of Italy and from all over the world have been successfully treated.
\r\nThanks to its proven expertise and high quality health care and due to the relevant scientific contribution of its medical staff, Policlinico San Donato was recognized by the Italian Ministry of Health as Institute for Research, Hospitalization and Health Care for the study and treatment of cardiac and great vessel diseases (Istituto di Ricovero e Cura a Carattere Scientifico per lo studio e la cura delle Malattie del cuore e dei grandi vasi nell’adulto e nel bambino – Ministerial Decree, 6 March 2006).
\r\nOur research activities are directly connected with healthcare providing specialized and tailored therapies and treatment to every patient, from fetuses to oldest old people.
\r\nOur research projects are predominantly clinical with a translational approach supported by our biomolecular, bioengineering and advanced-imaging research laboratories. Heart failure, valvular heart diseases, Brugada Syndrome, congenital cardiopathies, aortic diseases and cardiometabolic diseases are the major interests of the lines of research pursued by our IRCCS.