Previous TAVR in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR) affects improvement of MR

Figures

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  Fig 1. Procedural and echocardiographic characteristics before PMVR. The patient collective undergoing percutaneous edge-to-edge mitral valve repair (PMVR) was stratified into three cohorts according to a native aortic valve or a previous TAVR or SAVR procedure. A) Percentage of patients undergoing the PMVR procedure in deep sedation (DS) or in general anesthesia (GA). B) Procedure time for PMVR. Boxplots are depicting the median and the upper and lower quartile. C) The mitral valve anterior-posterior (ap) diameter is significantly smaller in patients with previous TAVR. Boxplots are depicting the median and the upper and lower quartile. D) The mitral valve ellipticity index was calculated at baseline. We observed no significant difference between patients with TAVR and without previous TAVR. Boxplots depict the median and the upper and lower quartile. E) Left panel: LVOT view in TEE demonstrating the anatomic situation in a patient with a native aortic valve (white asterisk indicates anterior mitral valve leaflet). Right panel: LVOT view in TEE demonstrating the anatomic situation in a patient after TAVR. Note the close relation of the distal part of the TAVR prothesis and the anterior…

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  Fig 2. Procedural success of the PMVR procedure. A) Comparison of procedural failure. Procedural failure was 1.4% in the native aortic valve cohort vs 4.8% in the TAVR cohort (p = 0.23 vs. the cohort of patients with a native aortic valve) and 5.6% in the SAVR cohort.

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  Fig 3. Procedural complications. A) There was no significant difference in post-interventional leukocyte count in patients with a TAVR prosthesis and those without. Boxplots depict the median and the upper and lower quartile. B) There was no significant difference in post-interventional CRP levels in patients with a TAVR prosthesis and those without. Boxplots show the median and the upper and lower quartile. C) No difference between the TAVR and the control cohorts could be detected with regard to life-threatening and major bleedings, while there were significantly more minor bleedings in the TAVR cohort (p = 0.02).

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  Fig 4. Procedural outcomes. A) In the cohort of patients with a native aortic valve a reduction of MR of at least 3 grades was achieved in 45.7% of patients as compared to 19.0% of patients in the cohort with TAVR (p = 0.02 vs. the cohort of patients with a native aortic valve) and 55.6% in the cohort with SAVR. B) Color flow doppler imaging (LVOT view in TEE) of the MR before (left panel) and after (right panel) the PMVR procedure in a patient with a native aortic valve. C) Color flow doppler imaging (LVOT view in TEE) of the MR before (left panel) and after (right panel) the PMVR procedure in a patient with a TAVR prothesis (white arrow indicates the TAVR prosthesis). D) Cardiac output after PMVR was 5.5 ± 1.9 l/min in the cohort with a native aortic valve, 4.1 ± 1.2 l/min in the cohort with TAVR (p = 0.01 vs. the cohort of patients with a native aortic valve) and 6.2 ± 1.6 l/min in the cohort with SAVR.