Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease: Preliminary Results From a Prospective Single-Center Study

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<0.0001), MV annulus areas (2D annulus area, 13.9±3.8 and 12.8±3.4 cm2; P<0.0001 and 3D annulus area, 14.4±3.9 and 12.9±3.4 cm2; P<0.0001), and MV annular geometry (MV sphericity index, 0.9±0.1 and 0.8±0.1; P<0.0001); the lateral medial MV diameters remained unchanged (4.3±0.7 and 4.4±0.6 cm; P=0.13). In subjects with DMR, all MV annular geometry-defining values were not significantly altered after TMVR (n=36; 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.

[1]  M. De Carlo,et al.  Integrated reverse left and right ventricular remodelling after MitraClip implantation in functional mitral regurgitation: an echocardiographic study. , 2014, European heart journal cardiovascular Imaging.

[2]  N. Weissman,et al.  Relationship Between the Magnitude of Reduction in Mitral Regurgitation Severity and Left Ventricular and Left Atrial Reverse Remodeling After MitraClip Therapy , 2013, Circulation.

[3]  R. Siegel,et al.  Peri-interventional echo assessment for the MitraClip procedure. , 2013, European heart journal cardiovascular Imaging.

[4]  C. McCulloch,et al.  Echocardiographic predictors of single versus dual MitraClip device implantation and long‐term reduction of mitral regurgitation after percutaneous repair , 2013, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[5]  J. Hausleiter,et al.  Clinical outcomes through 12 months in patients with degenerative mitral regurgitation treated with the MitraClip® device in the ACCESS-EUrope Phase I trial. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[6]  S. Blankenberg,et al.  Aetiology of mitral regurgitation differentially affects 2‐year adverse outcomes after MitraClip therapy in high‐risk patients , 2013, European journal of heart failure.

[7]  J. Zamorano,et al.  Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. , 2013, European heart journal cardiovascular Imaging.

[8]  P. Boekstegers,et al.  Acute outcomes after MitraClip therapy in highly aged patients: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) Registry. , 2013, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[9]  T. Münzel,et al.  Immediate effect of the MitraClip procedure on mitral ring geometry in primary and secondary mitral regurgitation. , 2013, European heart journal cardiovascular Imaging.

[10]  O. Alfieri,et al.  Mitraclip therapy and surgical mitral repair in patients with moderate to severe left ventricular failure causing functional mitral regurgitation: a single-centre experience. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[11]  W. Lehmacher,et al.  Analysis of Procedural Effects of Percutaneous Edge-to-Edge Mitral Valve Repair by 2D and 3D Echocardiography , 2012, Circulation. Cardiovascular imaging.

[12]  P. Chan,et al.  Real-world experience of MitraClip for treatment of severe mitral regurgitation. , 2012, Circulation journal : official journal of the Japanese Circulation Society.

[13]  K. Kuck,et al.  MitraClip therapy in daily clinical practice: initial results from the German transcatheter mitral valve interventions (TRAMI) registry , 2012, European journal of heart failure.

[14]  M. Cheitlin Percutaneous Repair or Surgery for Mitral Regurgitation , 2012 .

[15]  R. Wachter,et al.  Impact of the learning curve on outcomes after percutaneous mitral valve repair with MitraClip® and lessons learned after the first 75 consecutive patients , 2011, European journal of heart failure.

[16]  H. Reichenspurner,et al.  Impact of MitraClip™ therapy on secondary mitral valve surgery in patients at high surgical risk. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[17]  T. Meinertz,et al.  MitraClip® therapy in patients with end‐stage systolic heart failure , 2011, European journal of heart failure.

[18]  J. Gorman,et al.  Percutaneous repair or surgery for mitral regurgitation. , 2011, The New England journal of medicine.

[19]  Ben A. Lin,et al.  Color Doppler jet area overestimates regurgitant volume when multiple jets are present. , 2010, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[20]  H. Reichenspurner,et al.  Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction. , 2010, European heart journal.

[21]  Antonio Colombo,et al.  Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting , 2010, European heart journal.

[22]  Scott Lim,et al.  Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. , 2009, Journal of the American College of Cardiology.

[23]  E. Foster,et al.  Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multicenter clinical trial of percutaneous mitral valve repair. , 2007, The American journal of cardiology.