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<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<0.001; Figure B) and at end-diastole (61.6±21.5 vs. 50.4±27.37 ml/m2; p<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.

scholarly journals Clinical and haemodynamic effects of percutaneous edge-to-edge mitral valve repair in atrial versus ventricular functional mitral regurgitation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M J Claeys ◽  
P Debonnaire ◽  
V Bracke ◽  
G Bilotta ◽  
N Shkarpa ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Functional Status ◽  
Mitral Valve Repair ◽  
Nyha Class ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Atrial Remodeling ◽  
Systolic Pulmonary Artery Pressure ◽  
Valve Repair

Abstract Background Atrial functional mitral regurgitation (A-FMR) is a novel entity characterized by a MR due to atrial remodeling but with preserved left ventricular (LV) systolic function. Purpose To assess the clinical and haemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with A-FMR as compared to ventricular (V)-FMR. Methods MR grade, functional status (NYHA class), and major adverse cardiac events (MACE= all-cause mortality or hospitalization for heart failure (HF)) were evaluated in 52 A-FMR patients (pts.) and in 307 V-FMR pts. who underwent MitraClip implantation in 7 Belgian centers. In a subgroup of 56 pts (10 A-FMR and 46 V-FMR) haemodynamic assessment during a symptom-limited exercise echocardiography was performed before and 6-month after intervention. Results MitraClip implantation resulted in similar MR reductions in A-FMR and V-FMR (MR grade ≤2 at 6-month in 94% versus 82%, respectively (p=0.08)) and was associated with improvement of functional status in both groups (NYHA class ≤2 at 6 months in 90% versus 80%, respectively (p=0.2)). Serial haemodynamic assessment revealed that the cardiac output at 6-month was significantly higher in A-FMR pts. both at rest (5.1±1.5 L/min versus 3.8±1.5 L/min, p=0.002) and during peak exercise (7.9±2.4 L/min versus 6.1±2.1 L/min, p=0.02). Also the reduction in systolic pulmonary artery pressure (sPAP) was more pronounced in A-FMR: Δ sPAP at rest – 13.1±15.1 mmHg versus – 2.2±13.3 mmHg (p=0.03). During a follow-up period of 1.3±1.2 years MACE rate was significantly lower in A-FMR versus V-FMR with an adjusted OR of 0.46 (95% CI 0.24–0.88, see figure), which was mainly driven by a reduction in HF hospitalization. Conclusion Percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. But, the haemodynamic and clinical impact is stronger in A-FMR pts. FUNDunding Acknowledgement Type of funding sources: None. MACE in A-FMR versus V-FMR pts

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

Clinical and echocardiographic outcomes of transcatheter mitral valve repair in atrial functional mitral regurgitation

2021 ◽  
Author(s):  
Tomás Benito-González ◽  
Fernando Carrasco-Chinchilla ◽  
Rodrigo Estévez-Loureiro ◽  
Isaac Pascual ◽  
Dabit Arzamendi ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair

Impact of recurrent mitral regurgitation after mitral valve repair for functional mitral regurgitation: long-term analysis of competing outcomes

2019 ◽  
Vol 40 (27) ◽  
pp. 2206-2214 ◽  
Author(s):  
Annelieke H J Petrus ◽  
Olaf M Dekkers ◽  
Laurens F Tops ◽  
Eva Timmer ◽  
Robert J M Klautz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
History Of ◽  
The Impact

Abstract Aims Recurrent mitral regurgitation (MR) has been reported after mitral valve repair for functional MR. However, the impact of recurrent MR on long-term survival remains poorly defined. In the present study, mortality-adjusted recurrent MR rates, the clinical impact of recurrent MR and its determinants were studied in patients after mitral valve repair with revascularization for functional MR in the setting of ischaemic heart disease. Methods and results Long-term clinical and echocardiographic outcome was evaluated in 261 consecutive patients after restrictive mitral annuloplasty and revascularization for moderate to severe functional MR, between 2000 and 2014. The cumulative incidence of recurrent MR ≥ Grade 2, assessed by competing risk analysis, was 9.6 ± 1.8% at 1-year, 20.3 ± 2.5% at 5-year, and 27.6 ± 2.9% at 10-year follow-up. Cumulative survival was 85.8% [95% confidence interval (CI) 81.0–90.0] at 1-year, 67.3% (95% CI 61.1–72.6%) at 5-year, and 46.1% (95% CI 39.4–52.6%) at 10-year follow-up. Age, preoperative New York Heart Association Class III or IV, a history of renal failure, and recurrence of MR expressed as a time-dependent variable [HR 3.28 (1.87–5.75), P < 0.001], were independently associated with an increased mortality risk. Female gender, a history of ST-elevation myocardial infarction, a preoperative QRS duration ≥120 ms, a higher preoperative MR grade, and a higher indexed left ventricular end-systolic volume were independently associated with an increased likelihood of recurrent MR. Conclusion Mitral valve repair for functional ischaemic MR resulted in a low incidence of recurrent MR with favourable clinical outcome up to 10 years after surgery. Presence of recurrent MR at any moment after surgery proved to be independently associated with an increased risk for mortality.

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