Immediate Post-Procedural and Discharge Assessment of Mitral Valve Function Following Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation and Association with Outcomes

The correlation between residual mitral regurgitation (rMR) grade or mitral valve pressure gradient (MVPG), at transcatheter edge-to-edge mitral valve repair (TEEMr) completion and at discharge, is unknown. Furthermore, there is disagreement regarding rMR grade or MVPG from which prognosis diverts. We retrospectively studied 82 patients that underwent TEEMr. We tested the correlation between rMR or MVPG and evaluated their association, with outcomes. Moderate or less rMR (rMR ≤ 2) at TEEMr completion was associated with improved survival, whereas mild or less rMR (rMR ≤ 1) was not. Patients with rMR ≤ 1 at discharge demonstrated a longer time of survival, of first heart failure hospitalization and of both. The correlation for both rMR grade (r = 0.5, p < 0.001) and MVPG (r = 0.51, p < 0.001), between TEEMr completion and discharge, was moderate. MR ≤ 2 at TMEER completion was the strongest predictor for survival (HR 0.08, p < 0.001) whereas rMR ≤ 1 at discharge was independently associated with a lower risk of the combined endpoint (HR 4.17, p = 0.012). MVPG was not associated with adverse events. We conclude that the assessments for rMR grade and MVPG, at the completion of TEEMr and at discharge, should be distinctly reported. Improved outcome is expected with rMR ≤ 2 at TEEMr completion and rMR ≤ 1 at discharge. Higher MVPG is not associated with unfavorable outcomes.

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Right ventricular reserve post mitral valve repair is associated with heart failure hospitalization

Pulmonary Circulation ◽

10.1177/2045894020943858 ◽

2020 ◽

Vol 10 (4) ◽

pp. 204589402094385

Author(s):

Wei-Ting Chang ◽

Nan-Chun Wu ◽

Jhih-Yuan Shih ◽

Chih-Hsin Hsu ◽

Zhih-Cherng Chen ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Right Ventricular ◽

Mitral Valve Repair ◽

Cardiovascular Outcomes ◽

Left Ventricular Ejection ◽

Heart Failure Hospitalization ◽

Valve Repair ◽

Right Ventricular Strain

Right ventricular impairment is a predictor of cardiovascular outcomes in patients with degenerative mitral regurgitation. However, the time course of right ventricular functional changes post-surgical mitral valve repair remains largely unknown. Herein, using right ventricular-focused echocardiography, we aimed to investigate right ventricular reserve and its impact on hospitalization for heart failure after mitral valve repair. In this prospective study, we enrolled 108 patients scheduled to undergo surgical repair of degenerative mitral regurgitation. Echocardiography, including right ventricular strain analysis, was performed prior to, and one month and six months post mitral valve repair. Right ventricular strain that improved one month post-surgery was defined as reserved right ventricular. In addition, any cardiovascular outcomes comprising heart failure that required admission were recorded. The median follow-up duration is 31 months. Despite a significant improvement in mitral valve regurgitant volume post-operatively, left ventricular ejection fraction (LVEF) at six months was similar to LVEF at baseline. There was a transient decrease in LV longitudinal strain at one month that was recovered six months post mitral valve repair. Regarding the right ventricular, in contrast with conventional right ventricular parameters, including right ventricular tissue Doppler S′, fractional area change and tricuspid annular plane systolic excursion (TAPSE), only resolution of right ventricular strain at one month predicted the subsequent myocardial recovery. Furthermore, patients with reserved right ventricular had a lower risk of hospitalization for heart failure compared to those with non-reserved right ventricular. Collectively, the early resolution of right ventricular strain is associated with the improvement in right ventricular function (measured by TAPSE) and in heart failure hospitalization in patients who had undergone surgical mitral valve repair for degenerative mitral regurgitation.

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Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2019.06.008 ◽

2020 ◽

Vol 21 (1) ◽

pp. 52-60 ◽

Cited By ~ 4

Author(s):

Tomás Benito-González ◽

Rodrigo Estévez-Loureiro ◽

Pedro A. Villablanca ◽

Patrizio Armeni ◽

Ignacio Iglesias-Gárriz ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Medical Therapy ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair

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The Novel Use of Mitraclip in a Patient with Combined Multiple Myeloma and Heart Failure with Severe Mitral Regurgitation

Austin Cardio & Cardiovascular Case Reports ◽

10.26420/austincardiocardiovasccaserep.2021.1039 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Abu Ghosh Z ◽

◽

Beeri R ◽

Falah B ◽

Pertz A ◽

...

Keyword(s):

Heart Failure ◽

Multiple Myeloma ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Severe Mitral Regurgitation ◽

The Novel ◽

Valve Repair ◽

Oncological Treatment ◽

Patients With Heart Failure

Oncology patients with Heart Failure (HF) and severe Mitral Regurgitation (MR) are often considered to have a prohibitive risk for surgical mitral valve repair/replacement. We describe a patient with active multiple myeloma and significant HF and MR who was treated with MitraClip, which improved symptoms and allowed delivery of optimal oncological treatment.

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Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

Scientific Reports ◽

10.1038/s41598-020-74407-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Alberto Polimeni ◽

Michele Albanese ◽

Nadia Salerno ◽

Iolanda Aquila ◽

Jolanda Sabatino ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Primary Endpoint ◽

Cardiovascular Death ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair ◽

Percutaneous Valve Repair ◽

Percutaneous Valve

Abstract Percutaneous mitral valve repair has been increasingly performed worldwide after approval. We sought to investigate predictors of clinical outcome in patients with mitral regurgitation undergoing percutaneous valve repair. The MITRA-UMG study, a single-centre registry, retrospectively collected consecutive patients with symptomatic moderate-to-severe or severe MR undergoing MitraClip therapy. The primary endpoint was the composite of cardiovascular death or rehospitalization for heart failure. Between March 2012 and July 2018, a total of 150 consecutive patients admitted to our institution were included. Procedural success was obtained in 95.3% of patients. The composite primary endpoint of cardiovascular death or rehospitalization for HF was met in 55 patients (37.9%) with cumulative incidences of 7.6%, 26.2%, at 30 days and 1-year, respectively. In the Cox multivariate model, NYHA functional class and left ventricular end-diastolic volume index (LVEDVi), independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan–Meier analysis, a LVEDVi > 92 ml/m2 was associated with an increased incidence of the primary endpoint. In this study, patients presenting with dilated ventricles (LVEDVi > 92 ml/m2) and advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis after percutaneous mitral valve repair.

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Percutaneous Mitral Valve Repair for Functional Mitral Regurgitation with End-Stage Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.08.071 ◽

2015 ◽

Vol 21 (10) ◽

pp. S157

Author(s):

Yukiko Mizutani ◽

Shunsuke Kubo ◽

Makar Moody ◽

Mamoo Nakamura ◽

Takahiro Shiota ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair ◽

End Stage Heart Failure ◽

End Stage

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Long-Term Outcome of Patients with Severe Biventricular Heart Failure and Severe Mitral Regurgitation After Percutaneous Edge-to-Edge Mitral Valve Repair

Journal of Interventional Cardiology ◽

10.1111/joic.12193 ◽

2015 ◽

Vol 28 (2) ◽

pp. 164-171 ◽

Cited By ~ 19

Author(s):

MARTIN ORBAN ◽

DANIEL BRAUN ◽

MATHIAS ORBAN ◽

CHRISTIAN GREBMER ◽

DIRK SIBBING ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Severe Mitral Regurgitation ◽

Valve Repair ◽

Term Outcome ◽

Long Term Outcome

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

Journal of the American Heart Association ◽

10.1161/jaha.120.019548 ◽

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.

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