BCMS Medical Record Fall 2020 - 25

post-discharge from the hospital. However, the tree diagram on
its own is a very general overview and does not break down the
probability of each occurrence. Thus, another test is necessary to
solidify these findings.
After determining the relationship that exists between the
variables and their consequences, we have to determine whether or
not these relationships are correlations or if a statistically significant
relationship has been established. Though the tree diagram
indicated no correlation, the relatedness of each variable cannot
be statistically ruled out. The contingency table was used to test
specific variables against one another. Each pre-existing condition
was broken down and tested against specific postoperative
complications. If the relationship between the variables and
postoperative complications is merely correlation, then the success
of the clip itself is left to speculation (in terms of longevity).
Three contingency tables were designed to test three of the
"umbrella categories." Based on the result of each contingency
table, there proved to be a higher chance of complication for
patients with severe MR, dilated vascular disease, and <30%
ejection fraction. In each of these categories the % row and %
column, which calculate the percent of patients with the given
conditions vs. the overall sample, are higher, raising concern.
However, to confirm the statistical significance, the p-value below
each contingency table must be considered. If the p-value is less
than 0.005, it is typically considered to be statistically significant,
meaning chance is highly unlikely to account for the finding. MR
severity, underlying cardiac complications, and ejection fraction all
have p-values below the desired 0.005 target, indicating that there
is a statistically significant relationship between these variables and
postoperative complications.

Conclusions:

The tree diagram and the contingency table provide a
comprehensive overview of the success rate of the Mitraclip.
Based on the information above, we can conclude that there is an
increased risk of postoperative complications when one has preexisting severe MR, <30% ejection fraction, or if the patient was
previously diagnosed with dilated cardiomyopathy. These patients
should proceed with caution or opt for a valve replacement surgery.
There was no relationship between gender and success rate. While
the results proved statistically significant, the test is limited in its
predictive nature. The data provides reassurance that the Mitraclip
is a great treatment option for anyone that does not meet the above
criteria. However, there will be a more reliable understanding of its
efficacy and longevity as more experience with mitraclip is obtained
over time.

Work Cited
Baldus, S., Schillinger, W., Franzen, O., Bekeredjian, R., Sievert,
H., Schofer, J., Kuck, K., Konorza, T., Möllmann, H., Hehrlein, C.,
Ouarrak, T., Senges, J. and Meinertz, T., 2012. MitraClip therapy in
daily clinical practice: initial results from the German transcatheter
mitral valve interventions (TRAMI) registry. European Journal of
Heart Failure, 14(9), pp.1050-1055.

Boudoulas, Konstantinos Dean, and Harisios Boudoulas. "An Evolution
Of Management In Hypertrophic Cardiomyopathy: Myectomy,
Alcohol Septal Ablation, Mitral Valve Replacement, Mitraclip".
Cardiology, vol 137, no. 1, 2017, pp. 54-57. S. Karger AG,
doi:10.1159/000455068. Accessed 11 July, 2020.
Cho, In-Jeong et al. "Different Characteristics, Clinical Outcomes,
And Left Atrial Reverse Remodeling In Patients With Mitral Stenosis
Maintaining Sinus Rhythm For At Least 10 Years After Successful
Percutaneous Mitral Valvuloplasty". Cardiology, vol 140, no. 1, 2018,
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"FDA Approves New Indication For Valve Repair Device To Treat
Certain Heart Failure Patients With Mitral Regurgitation". U.S. Food
And Drug Administration, 2020, https://www.fda.gov/news-events/
press-announcements/fda-approves-new-indication-valve-repair-devicetreat-certain-heart-failure-patients-mitral#:~:text=When%20first%20
approved%20in%202013,primary%20or%20degenerative%20
mitral%20regurgitation).
Grasso, Carmelo et al. "Strategies And Outcomes Of Repeat
Mitral Valve Interventions After Failed Mitraclip Therapy".
Cardiology, vol 137, no. 2, 2017, pp. 114-120. S. Karger AG,
doi:10.1159/000460240. Accessed 2 July, 2020.
Huntgeburth, Michael et al. "End-Tidal CO2 Predicts Reduction In
Mitral Regurgitation In Patients Undergoing Percutaneous Mitral
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Iorio, Annamaria et al. "Mitraclip After Heart Transplantation: A
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1 July, 2020.
Maisano, F., Godino, C., Giacomini, A. et al. Clinical trial experience
with the MitraClip catheter based mitral valve repair system. Int J
Cardiovasc Imaging 27, 1155-1164 (2011). https://doi.org/10.1007/
s10554-011-9872-8
"Mitral Valve Regurgitation - Diagnosis And Treatment - Mayo
Clinic". Mayoclinic.Org, 2020,
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"Mitral Valve Repair Risks / Benefits | Cleveland Clinic". Cleveland
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Seifert, Martin et al. "Mitraclip In CRT Non-Responders With
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Paige Cincinnati is a pre-med student in her 3rd year at the
University of Tennessee - Knoxville, pursuing a dual major
in Neuroscience and English.

FALL 2020

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BCMS Medical Record Fall 2020

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