scholarly journals Long-Term survival and functional status in patients with elevated mitral valve pressure gradient after transcatheter mitral valve repair

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Koell ◽  
S Ludwig ◽  
J Weimann ◽  
L Waldschmidt ◽  
N Schofer ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Pressure Gradient ◽  
Functional Outcome ◽  
Mitral Valve Repair ◽  
Cox Regression ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Kaplan Meier ◽  
Valve Pressure

Abstract Background A growing number of patients are currently treated for severe mitral regurgitation (MR) using a transcatheter mitral valve repair (TMVr). In clinical routine, the potential risk of elevated post-procedural mitral valve pressure gradient (MPG) may prohibit optimal MR reduction driven by the avoidance of additional clip implantations. Thus, the unfavorable impact on survival and functional outcome of increased MPG in patients undergoing TMVr is currently debatable. Methods In this single-center, prospective study, survival and functional outcome of 780 consecutive patients with severe MR undergoing TMVr between September 2008 and January 2020 were investigated. After exclusion of patients with unsuccessful procedure and those lost to follow-up, data of 676 patients with a median follow-up time of 5.26 (5.11, 5.51) years were analyzed. MPG was determined by transthoracic echocardiography at discharge and considered elevated in excess of 4.5 mmHg. Kaplan-Meier analysis as well as multivariable Cox regression models were performed for the impact on elevated MPG on 5-year outcomes for the subgroups of functional MR (FMR) and degenerative MR (DMR). The primary outcome measure was a combined endpoint of death or rehospitalization for congestive heart failure. Results Among 676 patients undergoing TMVr (mean age 74.6±8.5 years, 59.0% male, median STS Score 3.9 [interquartile range 2.5; 6.0]), 179 (26.4%) patients had elevated MPG >4.5 mmHg. FMR was present in 426 (63.0%) patients. In the overall patient cohort, Kaplan-Meier and Cox Regression analyses could not demonstrate significant differences for the combined endpoint (p=0.99). In contrast, subgroup analysis according to MR etiology indicated a significant adverse influence of elevated MPG on the combined endpoint as well as functional outcome in patients with DMR, but not with FMR (Figure 1). After adjustment, multivariate Cox Regression analysis showed an inferior prognosis in patients with DMR and elevated MVPG >4.5 mmHg (hazard ratio 1.79 [1.17, 2.72], p=0.0069, Figure 2). Conclusions TMVr-patients with DMR and measurable elevated post-procedural MVPG face an inferior prognosis and reduced functional outcomes compared to patients with FMR. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Mitral Regurgitation International Database (MIDA) Score Predicts Outcome in Patients With Heart Failure Undergoing Transcatheter Edge‐to‐Edge Mitral Valve Repair

2021 ◽  
Author(s):  
Refik Kavsur ◽  
Maximilian Spieker ◽  
Christos Iliadis ◽  
Clemens Metze ◽  
Moritz Transier ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Rank Test ◽  
International Database ◽  
Valve Repair ◽  
Log Rank Test ◽  
Transcatheter Mitral Valve Repair

Background Optimizing risk stratification in patients undergoing transcatheter mitral valve repair is an ongoing challenge. The Mitral Regurgitation International Database (MIDA) score represents a user‐friendly mortality risk stratification tool that is validated on a large‐scale registry of patients with degenerative mitral regurgitation (MR). We here assessed the potential benefit of the MIDA risk score for patients with functional or degenerative MR undergoing transcatheter mitral valve repair. Methods and Results In total, 680 patients undergoing MitraClip implantation were stratified according to MIDA score tertiles into a low (0–7), intermediate (8–9), and a high (10–12) MIDA score group. MR was assessed in follow‐up echocardiograms in 416 patients at 323±169 days after transcatheter mitral valve repair. During 2‐year follow‐up, 8.2% (15/182) of patients with low, 21.3% (64/300) with intermediate, and 26.3% (52/198) with high MIDA score died (log‐rank test P <0.001). Hazard of all‐cause mortality increased by 13% (95% CI, 3%–25%) with every additional point of the MIDA score. Subanalysis of 431 patients with functional MR showed similar results. Furthermore, rates of a combined end point of mortality and hospitalization for heart failure were higher with increasing MIDA score (30% [54/182], 38% [113/300] and 48% [94/198], respectively, log‐rank test P =0.001). Frequency of residual MR ≥II at follow‐up increased with increasing MIDA score group (33%, 44%, and 59%, respectively, P <0.001). Conclusions The MIDA mortality risk score maintains its predictive utility in patients undergoing transcatheter mitral valve repair, regardless of MR cause. Moreover, it was predictive of worse event‐free survival regarding a combined end point of mortality and hospitalization for heart failure, and was associated with postprocedural residual MR ≥II and MR recurrence.

scholarly journals Same-Day Discharge After Transcatheter Mitral Valve Repair using MitraClip in a tertiary community hospital—A case series

2021 ◽  
Author(s):  
Medhat Chowdhury ◽  
Rupinder Buttar ◽  
Devesh Rai ◽  
Muhammad Waqas Tahir ◽  
Bryan E-Xin Tan ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Hospital Stay ◽  
Mitral Valve Repair ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Mitral Valve Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Same Day Discharge

Abstract Background Due to the current COVID-19 pandemic, there is a realization for innovation in procedures and protocols to minimize hospital stay and at the same time ensure continued evidence-based treatment delivered to the patients. We present a same-day discharge protocol for transcatheter mitral valve repair (TMVR) using MitraClip under general anesthesia in a six-patient case series. This protocol aims to reduce length of hospital stay, thereby minimizing potential for nosocomial COVID-19 infections and to promote safe discharge with cautious follow-up. Case Summary Six patients with severe symptomatic mitral valve regurgitation underwent successful transfemoral mitral valve repair using standard procedures. Following repair, patients were monitored on telemetry in the recovery area for 3 hours, ambulated to assess vascular access stability and underwent post-procedural transthoracic echocardiogram to assess for any pericardial effusion or post-procedural prosthetic mitral stenosis. Conclusion Same day discharge after TMVR is possible when done cautiously with close Follow-up, can minimize hospital stay, improve resource utilization and reduce risk of nosocomial COVID-19 infection.

P4724Elevated mitral valve pressure gradient is predictive for long-term outcome after percutaneous edge-to-edge mitral valve repair (PMVR) in patients with degenerative MR, but not in functional MR

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Patzelt ◽  
W Zhang ◽  
R Sauter ◽  
M Mezger ◽  
H Nording ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Cox Regression ◽  
Regression Analyses ◽  
Valve Repair ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Patient Cohort ◽  
Kaplan Meier ◽  
Valve Pressure

Abstract Background To analyze the effects of residual mitral regurgitation (MR) and mean mitral valve pressure gradient (MVPG) after percutaneous edge-to-edge mitral valve repair (PMVR) using the MitraClip-system on long term outcome. Methods and results Two hundred fifty-five patients who underwent PMVR were analyzed. Kaplan-Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical endpoint (all-cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used. After PMVR, mean MVPG increased from 1.6±1.0 mmHg to 3.1±1.5 mmHg (p<0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive for the combined endpoint while elevated MVPG >4.4 mmHg was not according to Kaplan-Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities.In the cohort with degenerative MR, elevated MVPG was associated with increased occurrence of the primary endpoint, whereas this was not observed in the cohort with functional MR. Conclusions MVPG >4.4 mmHg after MitraClip-implantation was predictive for clinical outcome in the patient cohort with degenerative MR. In the patient cohort with functional MR, MVPG >4.4 mmHg was not associated with increased clinical events. Acknowledgement/Funding This study was supported by grants from the German Research Foundation (KFO 274), the Volkswagen Foundation (Lichtenberg Program) and the German Heart

P5574Prognostic impact of left atrial function following transcatheter mitral valve repair

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Ledwoch ◽  
C Fellner ◽  
F Poch ◽  
I Olbrich ◽  
R Thalmann ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Clinical Outcome ◽  
Ejection Fraction ◽  
Mitral Valve Repair ◽  
Left Atrial ◽  
Left Ventricular Ejection ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
All Cause Mortality

Abstract Background Left atrial (LA) function predicts clinical outcome in a variety of cardiovascular diseases. However, limited data is available in the setting of mitral regurgitation (MR). Purpose The aim of the present study was to assess potential changes in LA ejection fraction (LA-EF) and its prognostic value in patients following transcatheter mitral valve repair using the mitraclip. Methods A total of 88 consecutive patients undergoing mitraclip implantation with complete echocardiography at baseline and follow-up between 3 and 6 months post-procedure were enrolled. Results LA-EF improved in 58% of the population. Change in LA-EF was associated with residual MR, residual transmitral gradient and left ventricular ejection fraction (LV-EF) changes. Compared to their counterparts, patients with residual MR ≥ grade 2 (−6% [−9 to 1%] vs. 4% [−5 to 15%]; p=0.05) and with residual transmitral gradient ≥5 mmHg (−2% [−9 to 9%] vs. 5% [−4 to 16%]; p=0.03) showed a decline in LA-EF, respectively. Furthermore, LA-EF significantly correlated with changes in LV-EF (r=0.40; p=0.001). With regards to clinical outcome, heart failure symptoms as assessed by NYHA class were more severe in patients with worsened LA-EF at follow-up. Finally, LA-EF change was identified as independent predictor of all-cause mortality (HR 0.94 [0.90–0.98]; p=0.008). Kaplan-Meier estimates for survival Conclusion The present analysis showed changes in LA function in patients undergoing mitraclip implantation to be associated with important measures including residual MR, elevated transmitral gradient and LV function. Importantly, LA function alterations represent a strong predictor for all-cause mortality.

Impact of transcatheter mitral valve repair on ventricular arrhythmias

EP Europace ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1385-1391 ◽  
Author(s):  
Jakob Ledwoch ◽  
Anna Nommensen ◽  
Ahmed Keelani ◽  
Roza Meyer-Saraei ◽  
Thomas Stiermaier ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Interquartile Range ◽  
Left Ventricular Ejection ◽  
Premature Ventricular Complex ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair

Abstract Aims Patients with heart failure and severe mitral regurgitation (MR) have a poor prognosis and carry an increased risk for ventricular arrhythmias. The present study evaluates the impact of transcatheter mitral valve repair using the MitraClip on the potential reduction of ventricular arrhythmias. Methods and results Patients undergoing MitraClip implantation were prospectively enrolled into the present study and received 24 h Holter ECG assessment prior to and 6 months after the procedure. In addition, left ventricular dimensions and function were assessed at baseline and follow-up. A total of 50 patients with mainly functional MR (82%) were included. Non-sustained or sustained ventricular tachycardia (nsVT and/or sVT) occurred in 32% of patients and was reduced to 14% at follow-up (P = 0.01). Also, premature ventricular complex (PVC) burden ≥5% decreased from 16% to 4% (P = 0.04). Patients with persistent (n = 6) or new (n = 1) nsVT and/or sVT at follow-up showed a significant decrease in left ventricular ejection fraction from 38% (interquartile range 26–45%) to 33% (interquartile range 22–44%; P = 0.03). Conclusions In this prospective study, transcatheter mitral valve repair using MitraClip was associated with a reduced prevalence of ventricular arrhythmias. The subset of patients with persistent or new ventricular arrhythmias after MitraClip implantation showed progression of left ventricular dysfunction.

scholarly journals Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

2017 ◽  
Vol 5 (1) ◽  
pp. 193-196 ◽  
Author(s):  
Daniel Lavall ◽  
Bruno Scheller ◽  
Christian Werner ◽  
Axel Buob ◽  
Felix Mahfoud
Keyword(s):  
Mitral Valve ◽  
Pressure Gradient ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
Valve Pressure

scholarly journals Right ventricular dysfunction assessed by cardiovascular magnetic resonance is associated with poor outcome in patients undergoing transcatheter mitral valve repair

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245637
Author(s):  
Maximilian Spieker ◽  
Jonathan Marpert ◽  
Shazia Afzal ◽  
Athanasios Karathanos ◽  
Daniel Scheiber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
All Cause Mortality

Aims To evaluate whether CMR-derived RV assessment can facilitate risk stratification among patients undergoing transcatheter mitral valve repair (TMVR). Background In patients undergoing TMVR, only limited data exist regarding the role of RV function. Previous studies assessed the impact of pre-procedural RV dysfunction stating that RV failure may be associated with increased cardiovascular mortality after the procedure. Methods Sixty-one patients underwent CMR, echocardiography and right heart catheterization prior TMVR. All-cause mortality and heart failure hospitalizations were assessed during 2-year follow-up. Results According to RV ejection fraction (RVEF) <46%, 23 patients (38%) had pre-existing RV dysfunction. By measures of RV end-diastolic volume index (RVEDVi), 16 patients (26%) revealed RV dilatation. Nine patients (15%) revealed both. RV dysfunction was associated with increased right and left ventricular volumes as well as reduced left ventricular (LV) ejection fraction (all p<0.05). During follow-up, 15 patients (25%) died and additional 14 patients (23%) were admitted to hospital due to heart failure symptoms. RV dysfunction predicted all-cause mortality even after adjustment for LV function. Similarly, RVEDVi was a predictor of all-cause mortality even after adjustment for LVEDVi. Kaplan-Meier survival analysis unraveled that, among patients presenting with CMR indicative of both, RV dysfunction and dilatation, the majority (78%) experienced an adverse event during follow-up (p<0.001). Conclusion In patients undergoing TMVR, pre-existing RV dysfunction and RV dilatation are associated with reduced survival, in progressive additive fashion. The assessment of RV volumes and function by CMR may aid in risk stratification prior TMVR in these high-risk patients.

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