Impact of interventional edge-to-edge repair on mitral valve geometry

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• 作者：Robert Schueler^a ; ^{Robert.schueler@ukb.uni-bonn.de} ; Sarah Kaplan^a ; Charlotte Melzer^a ; Can Ö ; ztü ; rk^a ; Marcel Weber^a ; Jan-Malte Sinning^a ; Armin Welz^b ; Nikos Werner^a ; Georg Nickenig^a ; Christoph Hammerstingl^a
• 关键词：2DTOE ; two-dimensional transesophageal echocardiography ; 3DTOE ; three-dimensional transesophageal echocardiography ; AP ; anterior-posterior ; FU ; follow up ; LM ; lateral-medial ; LVEF ; left ventricular ejection fraction ; MV ; mitral valve ; PMR ; primary mitral regurgitation ; SMR ; secondary mitral regurgitation ; TMVR ; transcatheter mitral valve repair
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：468-475
• 全文大小：809 K
• 卷排序：230

文摘

The acute and long-term effects of interventional edge-to-edge repair on the mitral valve (MV) geometry are unclear.We sought to assess MV-annular geometry and the association of changes in MV-diameters with functional response one year after MitraClip implantation.MethodsConsecutive patients (n = 84; age 81.2 ± 8.3 years, logistic EuroSCORE 21.7 ± 17.9%) with symptomatic moderate-to-severe mitral regurgitation (MR) underwent MitraClip-procedure. MV-annular geometry was assessed with 3D TOE before, immediately and one year after clip implantation.Results96.7% of secondary mitral regurgitation (SMR) patients presented with moderate-to-severe MR, 3.3% with severe SMR, respectively. 66.7% of primary MR (PMR) patients had moderate-to-severe MR, and 33.3% severe PMR respectively. When analyzing immediate effects of MitraClipC on mitral geometry, only patients with SMR (n = 60, 71.4%) experienced significant reductions of the diastolic MV anterior-posterior diameters (AP: 3.9 ± 0.5 cm, 3.5 ± 0.7 cm; p < 0.001), and annulus-areas (2D: 12.9 ± 3.8 cm2, 12.6 ± 3.7 cm2; p < 0.001; 3D: 13.4 ± 3.8, 13.1 ± 3.2 cm2; p < 0.001). All measures on MV annular geometry were not significantly altered in patients with PMR (p > 0.05).After one year of follow-up, MV annular parameters remained significantly reduced in SMR patients (p < 0.05) and remained unchanged in subjects with PMR (p > 0.05).Only SMR patients experienced significant increase in 6 min walking distances (p = 0.004), decrease in pulmonary pressures (p = 0.007) and functional NYHA-class (p < 0.001); in patients with PMR only NYHA class improved after one year (p < 0.001).ConclusionEdge-to-edge repair with the MitraClip-system impacts on MV-geometry in patients with SMR with stable results after 12 months. Reduction of MV-annular dimensions was associated with higher rates of persisting MR reduction and better functional status in patients with SMR.