Monitoring of early hemodynamic changes after mitral transcatheter edge-to-edge repair using a wearable, non-invasive device

Background Mitral transcatheter edge-to-edge repair (M-TEER) is a well-established therapeutic intervention for mitral regurgitation in elderly patients who are considered unsuitable for surgical procedures. Although procedural success is typically evaluated through echocardiography, the hemodynamic changes occurring shortly after the intervention are not well characterized. Continuous noninvasive monitoring may offer novel insights into the early cardiovascular adaptations following M-TEER. Purpose The objective is to assess early hemodynamic changes following M-TEER by utilizing a continuous, wearable, noninvasive chest-patch device designed for multiparameter hemodynamic evaluation. Methods This single-center prospective study involved the enrollment of 40 patients undergoing M-TEER procedures between April 2024 and January 2025. Hemodynamic parameters were recorded at 15-minute intervals using wearable, noninvasive, photoplethysmography-based chest patch sensors for a minimum of 12 hours prior to and more than 24 hours following the intervention. The hemodynamic features recorded included cardiac output (CO), cardiac index (CI), stroke volume (SV), and systemic vascular resistance (SVR). Results Continuous monitoring was technically feasible in all 40 patients included in the study. The mean age of the participants was 79.1±10.3 years, with 21 patients (53%) being female. Following the M-TEER procedure, significant increases were observed in cardiac output (5.5±0.7 vs. 5.8±0.9 L/min, p=0.011), cardiac index (3.0±0.5 vs. 3.2±0.6 L/min/m², p=0.002), and stroke volume (77.0±13.8 vs. 78.0±14.3 ml, p=0.005), alongside a significant reduction in systemic vascular resistance (1398.7±332.1 vs. 1333.3±356.3 dynsec/cm5, p=0.004). Within the entire M-TEER cohort, the early increase in cardiac output varied according to the etiology of mitral regurgitation (p=0.026), with atrial secondary mitral regurgitation (90%) being more frequently observed among cardiac output responders compared to ventricular secondary mitral regurgitation (10%). Conclusions Continuous noninvasive hemodynamic monitoring following M-TEER is both feasible and indicative of procedure-specific early cardiovascular adaptations. The M-TEER procedure has been shown to elicit a beneficial hemodynamic effect, characterized by an enhancement in cardiac output and a reduction in systemic vascular resistance. Further extensive studies are required to ascertain the prognostic significance of the early hemodynamic response after M-TEER.