BCMS Medical Record Fall 2020 - 23

Since the re-evaluation in 2014, Mitraclip has become more
widely adopted by hospitals as a plan of care. The clip found its
stride in 2017, as more and more hospitals began to invest in the
product and study its potential success. However, many questions
remain unanswered. While the first few years have been successful,
the longevity of the device is still undetermined. Is the device
merely a palliating measure? Is the device more beneficial for mildto-moderate MR patients than CRT or valve replacement? If the
device proves to be as successful as mitral valve replacement, will
the less-invasive approach become the preferred technique?
To answer the basic question: to what extent will Mitraclip be
successful in patients with severe MR? I surveyed a series of case
studies and used the data to conduct a statistical analysis.

Methods:
1. Case Studies
1.1 Read case studies from 2013-2020 with patient registry
describing the procedure, preoperative and postoperative results
1.2 Studies from Europe and the United States were surveyed
and studied, examining the use of the device in a range of
patients: CRT non-responders vs. CRT responders, transplant
patients, death rates, transfusion rates, etc.
1.3 The case studies provided a registry used in the
statistical software. Registry should include preoperative and
postoperative conditions.

Figure 2.1

2. The Statistical Analysis
	2.1 JMP Software
	 JMP is a statistical modeling software that can analyze
categorical and numerical data in many visual fashions such as
charts and graphs. The software supports predictive modeling,
which allows the user to manipulate the data in a fashion that will
predict the outcome of a given trial. The techniques provided are
used in business firms and medical research labs to predict trends
and estimate the success rate of a given product. Two predictive
models were used to predict the success of Mitraclip patients: the
Tree Diagram, and the Contingency table. Each model was based
on patient registry information. All sample sets were above 450
patients. Three main case studies were used: n= 487, n=492, n=466
respectively. The preoperative and postoperative data would be used
to evaluate which preoperative and postoperative complications
would be most predictive of Mitraclip's future success. In each test,
three main categories were observed: MR severity, ejection fraction,
and pre-existing vascular disease. Each category will be tested
against the performance of the patient post op.
2.2 The Tree Diagram:
A tree diagram determines the predictability of an outcome
based on a given set of variables. In other words, it analyzes what
role certain variables play in the desired outcome. To interpret the
tree diagram, we look at the R2 value. The R2 value will illustrate
the relationship between the two variables. The R2 value lies
between -1 and +1. The + and - merely illustrate the direction
(Figures 2.1 and 2.2).

Figure 2.2
		
2.3 The Contingency Table:
The contingency table further breaks down the probability
that one would have complications after the clip is placed based
on the presence of preexisting conditions. The probability of
complications is calculated by cross-sectioning each condition and
possible outcome. Essentially, a chi-square analysis is conducted in
each 'cell' to determine the relationship of each variable (Figures
3.1-3.3).
continued on next page >

FALL 2020

|

23



BCMS Medical Record Fall 2020

Table of Contents for the Digital Edition of BCMS Medical Record Fall 2020

BCMS Medical Record Fall 2020 - 1
BCMS Medical Record Fall 2020 - 2
BCMS Medical Record Fall 2020 - 3
BCMS Medical Record Fall 2020 - 4
BCMS Medical Record Fall 2020 - 5
BCMS Medical Record Fall 2020 - 6
BCMS Medical Record Fall 2020 - 7
BCMS Medical Record Fall 2020 - 8
BCMS Medical Record Fall 2020 - 9
BCMS Medical Record Fall 2020 - 10
BCMS Medical Record Fall 2020 - 11
BCMS Medical Record Fall 2020 - 12
BCMS Medical Record Fall 2020 - 13
BCMS Medical Record Fall 2020 - 14
BCMS Medical Record Fall 2020 - 15
BCMS Medical Record Fall 2020 - 16
BCMS Medical Record Fall 2020 - 17
BCMS Medical Record Fall 2020 - 18
BCMS Medical Record Fall 2020 - 19
BCMS Medical Record Fall 2020 - 20
BCMS Medical Record Fall 2020 - 21
BCMS Medical Record Fall 2020 - 22
BCMS Medical Record Fall 2020 - 23
BCMS Medical Record Fall 2020 - 24
BCMS Medical Record Fall 2020 - 25
BCMS Medical Record Fall 2020 - 26
BCMS Medical Record Fall 2020 - 27
BCMS Medical Record Fall 2020 - 28
BCMS Medical Record Fall 2020 - 29
BCMS Medical Record Fall 2020 - 30
BCMS Medical Record Fall 2020 - 31
BCMS Medical Record Fall 2020 - 32
BCMS Medical Record Fall 2020 - 33
BCMS Medical Record Fall 2020 - 34
BCMS Medical Record Fall 2020 - 35
BCMS Medical Record Fall 2020 - 36
BCMS Medical Record Fall 2020 - 37
BCMS Medical Record Fall 2020 - 38
BCMS Medical Record Fall 2020 - 39
BCMS Medical Record Fall 2020 - 40
BCMS Medical Record Fall 2020 - 41
BCMS Medical Record Fall 2020 - 42
BCMS Medical Record Fall 2020 - 43
BCMS Medical Record Fall 2020 - 44
BCMS Medical Record Fall 2020 - 45
BCMS Medical Record Fall 2020 - 46
BCMS Medical Record Fall 2020 - 47
BCMS Medical Record Fall 2020 - 48
BCMS Medical Record Fall 2020 - 49
BCMS Medical Record Fall 2020 - 50
BCMS Medical Record Fall 2020 - 51
BCMS Medical Record Fall 2020 - 52
BCMS Medical Record Fall 2020 - 53
BCMS Medical Record Fall 2020 - 54
BCMS Medical Record Fall 2020 - 55
BCMS Medical Record Fall 2020 - 56
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Fall2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Spring2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Winter2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BCMS_MedicalRecord_Fall2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Spring2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Winter2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Fall2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksMedicalSocietyHealthWellnessDirectory
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksMedicalRecord_Spring2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksMedicalRecord_Winter2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Fall2018
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2018
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Spring2018b
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Winter2017-18
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_Physician_Fall2017
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2017
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/MedicalRecordSpring2017
https://www.nxtbookmedia.com