Key result
Percutaneous edge-to-edge mitral valve repair was associated with new left ventricular thrombus formation in 21% of patients with LVEF ≤20%, compared to 0% in patients with LVEF >20%.
Why the study?
Does percutaneous edge-to-edge mitral valve repair cause left ventricular thrombus formation in patients with severe mitral regurgitation and end-stage systolic heart failure?
Observational (n=150)
No
Does percutaneous edge-to-edge mitral valve repair cause left ventricular thrombus formation in patients with severe mitral regurgitation and end-stage systolic heart failure?
Absolute Event Rate: 21% vs 0%
Percutaneous edge-to-edge mitral valve repair may be associated with a high risk of new left ventricular thrombus formation (21%) in patients with severely depressed LVEF (≤20%).
May support closer post-procedural LV thrombus surveillance in severe systolic dysfunction; leaves open need for prospective confirmation.
AIMS: To evaluate the characteristics and clinical outcome of patients with new formation of left ventricular (LV) thrombus after percutaneous edge-to-edge mitral valve repair. METHODS AND RESULTS: Between 2009 and 2012 we intended to treat 150 patients with severe mitral regurgitation (MR) with percutaneous edge-to-edge mitral valve repair in our centre. Post-procedural transthoracic echocardiographic examinations scheduled during the hospital stay revealed the new formation of LV thrombi in three out of 150 patients. All three patients suffered from end-stage systolic heart failure with a LV ejection fraction (LVEF) below 20% and were successfully treated in terms of MR reduction (reduction of at least two MR grades). No thrombus formation was observed in patients with a LVEF >20% treated in our centre (a total of 136 patients). The frequency of new LV thrombus formation in the cohort of patients with a LVEF ≤20% treated in our centre was 21% (three out of 14 patients). CONCLUSIONS: New formation of LV thrombus was detected in patients with severely depressed LVEF (≤20%) after successful reduction of MR following percutaneous edge-to-edge mitral valve repair. This phenomenon could be a play of chance, but percutaneous edge-to-edge mitral valve repair using the MitraClip¨ system is a new procedure. Special care is needed when performing new procedures, and the unexpected post-procedural finding of LV thrombus formation in approximately 20% in this cohort is worth reporting.
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Orban et al. (2014) conducted an observational in Severe mitral regurgitation (n=150). Percutaneous edge-to-edge mitral valve repair in patients with LVEF ≤20% vs. Percutaneous edge-to-edge mitral valve repair in patients with LVEF >20% was evaluated on New formation of left ventricular (LV) thrombus. Percutaneous edge-to-edge mitral valve repair was associated with new left ventricular thrombus formation in 21% of patients with LVEF ≤20%, compared to 0% in patients with LVEF >20%.
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