Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR

Figures

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  Fig. 1. (A) Scheme depicting segmental classification of the mitral valve used in this study. (B) Localisation of the first clip in all 410 patients (independent of genesis of the MR). 210 patients (51.2%) received no more than one clip. (C) Localisation of the second clip in the 200 patients, who got more than one clip (independent of genesis of the MR). 43 of these patients got more clips. (D) Localisation of the third clip in all 43 patients with more than two implanted clips (independent of genesis of the MR). In 4 of these patients more clips were implanted. (E) Localisation of the last clips in all 4 patients, who received more than three clips (independent of the genesis of MR). One of these patients had 5 clips implanted.

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  Fig. 2. A Patients with functional MR. Localisation of the first clip in all 178 patients with functional MR; 87 patients (48.9%) received no more than one clip (left panel). Localisation of the second clip in all 91 patients with functional MR, where more than one clip was implanted; 18 of these patients received more clips (middle panel). Localisation of the third clip in all 18 patients with functional MR, who got more than two clips. 2 of these patients got more clips (right panel). B Patients with degenerative MR. Localisation of the first clip in all 232 patients with degenerative MR; 123 patients (53.0%) received no more than one clip (left panel). Localisation of the second clip in all 109 patients with degenerative MR, where more than one clip was implanted; 25 of these patients received more clips (middle panel). Localisation of the third clip in all 25 patients with functional MR receiving more than two clips. 2 of these patients got more clips (right panel).

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  Fig. 3. A Shown is the mean of MR reduction (MR grade after PMVR compared to MR grade before PMVR) as a function of clip number. The comparison of 1 clip vs 4 clips and 2 clips vs 4 clips shows a significantly larger reduction. *p < 0.05 (one way ANOVA with post-hoc Tukey test) B In patients with degenerative MR, a significantly better reduction was achieved compared to patients with functional MR. n = 409; p < 0.05C Here, MR reduction was broken down by clip number and genesis of MR (functional vs. degenerative). When using one clip, MR reduction is significantly better in functional MR than in degenerative MR n(functional) = 87; n(degenerative = 123); p < 0.05. When two clips are used, MR reduction in degenerative MR is not significantly different from that in functional MR n(functional) = 73; n(degenerative = 83); p = 0.06. When three clips are used, MR reduction is significantly worse in functional MR than in degenerative MR n(functional) = 16; n(degenerative = 23); p < 0.05. D The average number of clips from patients with degenerative MR and functional MR did not differ significantly. n(functional) = 178; n(degenerative = 232); p = 0.64.

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  Fig. 4. The mean pressure gradient after PMVR is depicted according to the number of implanted clips for patients with functional MR (A) or for patients with degenerative MR (B).

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  Fig. 5. A Shown is the change in MR directly after the PMVR procedure in all patients compared with the follow-up after 6 months. Regardless of the number of clips, MR deteriorates by an average of half a grade within the first 6 months. B In the subgroup of patients with functional MR, MR reduction remains more stable (which means that MR grade does not increase any more over time) after three clips compared to only one clip (one factor ANOVA and post hoc Bonferroni p < 0.05). C In the subgroup of patients with degenerative MR there is no significant difference of MR stability depending on clip number (one factor ANOVA p > 0.05).