Impact of left ventricular systolic dysfunction on the outcomes of percutaneous edge-to-edge mitral valve repair using MitraClip

2016 ◽  
Vol 31 (12) ◽  
pp. 1988-1996 ◽  
Author(s):  
Hidehiro Kaneko ◽  
Michael Neuss ◽  
Thomas Schau ◽  
Jens Weissenborn ◽  
Christian Butter
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Valve Repair

scholarly journals Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jun Li ◽  
Yun Zhao ◽  
Tianyu Zhou ◽  
Yongshi Wang ◽  
Kai Zhu ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Valve Repair ◽  
Ventricular Systolic Function

Abstract Background This study aims to evaluate the early and mid-term outcomes of mitral valve repair for degenerative mitral regurgitation (MR) in patients with left ventricular systolic dysfunction. Methods From January 2005 to December 2016, the profiles of patients with degenerative MR who underwent mitral valve repair at our institution were analyzed. Left ventricular systolic dysfunction was defined as an ejection fraction < 60% or left ventricular end-systolic dimension > 40 mm. Finally, 322 patients with left ventricular systolic dysfunction were included in this study. The prognosis of left ventricular function during follow-up was evaluated and preoperative factors associated with deteriorated left ventricular systolic function during follow-up were analyzed. Results The in-hospital mortality rate was 1.6%. The rate of eight-year overall survival, freedom from reoperation for mitral valve and freedom from recurrent MR were 96.9, 91.2 and 73.4%, respectively. Intraoperative residual mild MR (hazard ratio 4.82) and an isolated anterior leaflet lesion (hazard ratio 2.48) were independent predictive factors for recurrent MR. During follow-up, 212 patients underwent echocardiography examinations at our institution. Among them, 132 patients had improved left ventricular systolic function, and 80 patients had deteriorated left ventricular systolic. Freedom from recurrent MR was found in 75.9% of the improved left ventricular systolic function group and 56.2% of the deteriorated left ventricular systolic function group (P = 0.047). An age > 50 years (odds ratio 2.40), ejection fraction≤52% (odds ratio 2.79) and left ventricular end-systolic dimension≥45 mm (odds ratio 2.31) were independent risk factors for deteriorated left ventricular systolic function during follow-up. Conclusions Mitral valve repair could be safely performed for degenerative MR in patients with left ventricular systolic dysfunction. Intraoperative residual mild MR and an isolated anterior leaflet lesion were independent predictive factors for recurrent MR. An age > 50 years, ejection fraction≤52% and left ventricular end-systolic dimension≥45 mm were independent risk factors for deteriorated left ventricular systolic function during follow-up.

scholarly journals Edge-to-edge transcatheter valve repair of atrial functional mitral regurgitation positively influences atrial pathology

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Petrescu ◽  
M Geyer ◽  
T Ruf ◽  
O Hahad ◽  
A Tamm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Mean Pressure

Abstract Introduction Functional mitral regurgitation (FMR) is the result of an insufficient coaptation of the mitral valve leaflets lacking relevant degeneration or morphological alterations of the valve apparatus. In most patients, this is caused by left ventricular (LV) systolic dysfunction and remodelling (ischemic or non-ischemic). However, a small subset of FMR patients is seen in the context of left atrial (LA) enlargement due to isolated atrial dilation in the absence of a ventricular pathology and has been termed “atrial functional MR” (AFMR) as a distinct etiology of FMR. The effect of transcatheter mitral valve repair (TMVR) by edge-to-edge-repair (e.g., MitraClip®) on AFMR reduction has not been studied, but it is considered to be effective regarding its effect on the anterior-posterior mitral annular diameter. Methods We retrospectively screened all 737 patients treated with TMVR by edge-to-edge repair in our center between January 2013 and April 2019. AFMR was defined as FMR with: (1) relevant LA dilatation, (2) no LV systolic dysfunction or (3) dilatation, (4) no ischemic etiology of FMR. LA mean pressure was invasively measured peri-interventionally before and after device implantation. Echocardiographic assessment was repeated at 1 year follow-up (1yFUP). Results Among 350 patients (47.5%) with FMR, 57 patients (16.3%) met the inclusion criteria for AFMR and were included in the data analysis. All patients in the AFMR group (mean age 81.4±5.7 years, 78.9% female) were symptomatic (82.2% functional NYHA class≥III) at baseline and were assessed to be at elevated risk for surgery (mean logistic EuroScore of 24.8±12.0%). TVMR was successfully performed in all patients without any peri-interventional major complications. At hospital discharge, 78.3% of patients had mild residual MR and 17.4% had no detectable MR. At 1 year, the echocardiographic prevalence of residual moderate MR was 11.4% and 2.9% of patients had severe MR (Figure A). Invasive LA mean pressure measurements were available in 39 patients (68.4%). In average, LA mean pressures decreased from 18.8 mmHg to 12.8 mmHg (p&lt;0.001). Analysis at 1yFUP showed a significant reduction in LA volume, both at end-systole (79.6±31.9 vs. 66.9±31.8 ml/m2 p&lt;0.001; Figure B) and at end-diastole (61.6±21.5 vs. 50.4±27.37 ml/m2; p&lt;0.01; Figure C). LA ejection fraction increased from 18.8%±12.6% to 30.1%±12.3% in 54.8% of patients. These findings were accompanied by a relevant symptomatic benefit (NYHA class I/II was found in 66.7% of patients at 1 year). Conclusions Transcatheter mitral valve repair by edge-to-edge therapy in symptomatic patients with atrial functional mitral regurgitation is safe and capable of a relevant reduction of mitral regurgitation severity accompanied by symptomatic improvement and positive atrial remodeling. FUNDunding Acknowledgement Type of funding sources: None.

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