percutaneous mitral valve repair with mitraclip in oncology patients with heart failure and severe mitral regurgitaion

Background: Cancer patients with heart failure (HF) and severe mitral regurgitation (MR) are often considered to have a prohibitive risk for surgical mitral valve repair/replacement. Severe MR inducing symptomatic HF may prevent delivery of potentially cardiotoxic chemotherapy, and complicate fluid management with other cancer treatments.

Methods: We studied a cohort of 145 patients who underwent Percutaneous Mitral Valve Repair (PMVR), MitraClip, at the Hadassah Medical Center between August 2015 and September 2019, among them 28 patients had active or history of cancer. Data from 28 cancer patients were compared to 117 “no-cancer” patients from the cohort.

Results: There was no significant difference in the mean age of cancer patients and patients without cancer (76 vs 80; p = 0.16). 67% of the patients had secondary (functional) MR. Among the cancer patients, 21 patients had solid tumor, while 7 patients had hematologic malignancies. 9 patients (32%) had active malignancy at the time of the PMVR procedure. The mean STS score of the patients was similar between the two groups 5.1%. Both 30-day and 1-year mortality rates were similar in the two groups (4% vs 7%; p = 0.52) and (16% vs 29%; p = 0.13) respectively.

Conclusion: PMVR in cancer patients is associated with similar 30-day and 1-year survival rate compared with patients without cancer.

PMVR should be considered favorably in cancer patients suffering from HF and severe MR, and not definitely excluded because of cancer related condition. This approach may allow these patients to receive planned oncological treatment more safely and improve symptoms.