ABSTRACT
INTRODUCTION: Intraprocedural assessment of mitral regurgitation (MR) is a challenging issue during the MitraClip procedure, which might influence not only the position but also the number of MitraClips implanted. Though transesophageal echocardiography (TEE) is the predominant tool used during the MitraClip procedure, MR assessment might be facilitated by a multimodality approach including continuous and simultaneous determination of left atrial and left ventricular (LV) pressure. METHODS: 86 consecutive patients (76.5 ± 8 years) who qualified for the MitraClip procedure were included into the study. In all patients, the multimodal assessment of MR (TEE, LV angiogram, TEE bubble evaluation, left atrial (LA) pressure => MitraScore) was performed after introducing the MitraClip guide catheter. In the first 42 patients (group A, no CAP), left atrial (LA) pressure (peak pressure of V-wave) was determined only before and after MitraClip implantation, whereas, in the subsequent 44 patients (group B, with CAP), continuous left atrial pressure monitoring (CAP) was performed. RESULTS: Patients with CAP (group B) had similar total procedural durations and no increase in the complication rate. MitraScore decreased from 10.5 to 3.5 in group A compared to 10.7 to *2.8 in group B (*P = 0.021 vs. group B). Whether the significant improvement of intraprocedural MR in group B translated into superior MR reduction in the conscious patient, was analyzed by transthoracic echocardiography (TTE) in a blinded fashion. Again MR reduction was significantly greater (P = 0.03) in group B (MR grade 2.8 to 0.9) as compared to group A (MR grade 2.8 to 1.3) and 2D vena contracta decreased from 0.54 ± 0.15 cm to 0.17 ± 0.10 in group B compared to group A (0.56 ± 0.19 cm to *0.23 ± 0.12; *P = 0.01 vs. group B). CONCLUSIONS: Multimodality assessment of intraprocedural MR supported by continuous left atrial pressure monitoring was associated with superior intraprocedural results translating into improved MR reduction also at the end of the hospital stay. © 2016 Wiley Periodicals, Inc.
Subject(s)
Atrial Function, Left , Atrial Pressure , Cardiac Catheterization/instrumentation , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/therapy , Mitral Valve/physiopathology , Monitoring, Physiologic/methods , Aged , Aged, 80 and over , Angiography , Cardiac Catheterization/adverse effects , Echocardiography, Doppler , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Female , Humans , Male , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Multimodal Imaging/methods , Predictive Value of Tests , Retrospective Studies , Time Factors , Treatment Outcome , Ventricular Function, LeftSubject(s)
Cardiac Catheterization , Heart Rupture, Post-Infarction/etiology , Mitral Valve Insufficiency/therapy , Mitral Valve/physiopathology , Myocardial Infarction/complications , Papillary Muscles/physiopathology , Shock, Cardiogenic/etiology , Aged , Cardiac Catheterization/instrumentation , Coronary Angiography , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Heart Rupture, Post-Infarction/diagnosis , Heart Rupture, Post-Infarction/physiopathology , Hemodynamics , Humans , Male , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Myocardial Infarction/diagnosis , Papillary Muscles/diagnostic imaging , Rupture, Spontaneous , Severity of Illness Index , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/physiopathology , Treatment OutcomeABSTRACT
The interventional treatment of mitral valve regurgitation by the MitraClip procedure has grown rapidly in Germany and Europe during the past years. The MitraClip procedure has the potential to treat high-risk patients with secondary mitral valve regurgitation and poor left ventricular function. Furthermore, patients with primary mitral valve regurgitation may be treated successfully by the MitraClip procedure in case of high surgical risk or in very old patients. At the same time it has been emphasised that the MitraClip interventional treatment is still at an early stage of clinical development. The largest clinical experience with the MitraClip procedure so far is probably present in some German cardiovascular centers, which here summarise their recommendations on the current indications and procedural steps of the MitraClip treatment. These recommendations of the AGIK and ALKK may present a basis for future development.
