In patients with functional mitral regurgitation, TMVR with MitraClip significantly reduced anterior-posterior MV diameters (4.0 to 3.6 cm, P<0.0001), which was associated with clinical response.
Observational (n=111)
Does transcatheter mitral valve repair with the MitraClip system acutely alter mitral valve geometry and predict functional response at 6 months in patients with high surgical risk mitral regurgitation?
Tasa de eventos absoluta: 3.6% vs 4%
valor p: p=< 0.0001
BACKGROUND: Transcatheter mitral valve repair (TMVR) is a treatment option in patients with symptomatic functional or degenerative mitral regurgitation (DMR) at high surgical risk. The acute effect of MitraClip procedure on mitral valve (MV) annular geometry and its relation to functional outcomes is unclear. We sought to assess immediate effect of TMVR on MV annular geometry with 3-dimensional (3D) transesophageal echocardiography and the association of MV diameter reduction with functional response after 6 months. METHODS AND RESULTS: Consecutive patients (n = 111; age, 78.3 ± 8.1 years) at high surgical risk (logistic EuroSCORE European System for Cardiac Operative Risk Evaluation, 29.8±21.5%) underwent TMVR. The procedure was completed successfully in 107 (96%) patients with 3D reconstruction of MV annular geometry immediately before and after clip implantation. Only patients with functional mitral regurgitation (n = 71) experienced an acute reduction of anterior-posterior MV diameters (4.0 ± 0.6 and 3.6 ± 0.6 cm; P 0.05). Acute anterior-posterior diameter reduction was associated with clinical response to TMVR after 6 months of follow-up (cutoff value, ≥ 6.4%; area under the curve, 0.81; P = 0.002; sensitivity, 81.6%; specificity, 81.8%), which was confirmed by additional regression analysis (P = 0.007). CONCLUSIONS: Three-dimensional transesophageal echocardiography enables assessment of acute changes of MV geometry in patients undergoing the MitraClip procedure. Only patients with functional mitral regurgitation experienced significant reduction of MV annular dimensions, which was associated with clinical response to TMVR.
Schueler et al. (Sun,) conducted a observational in Symptomatic functional or degenerative mitral regurgitation (n=111). Transcatheter mitral valve repair (TMVR) with MitraClip vs. Pre-procedure baseline was evaluated on Acute reduction of anterior-posterior mitral valve diameters in patients with functional mitral regurgitation (p=< 0.0001). In patients with functional mitral regurgitation, TMVR with MitraClip significantly reduced anterior-posterior MV diameters (4.0 to 3.6 cm, P<0.0001), which was associated with clinical response.