Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease

Abstract

Background-Transcatheter mitral valve repair (TMVR) is a treatment option in patients with symptomatic functional or degenerative mitral regurgitation (DMR) at high surgical risk. The acute effect of MitraClip procedure on mitral valve (MV) annular geometry and its relation to functional outcomes is unclear. We sought to assess immediate effect of TMVR on MV annular geometry with 3-dimensional (3D) transesophageal echocardiography and the association of MV diameter reduction with functional response after 6 months. , and MV annular geometry (MV sphericity index, 0.9±0.1 and 0.8±0.1; P<0.0001); the lateral medial MV diameters remained unchanged (4.3±0.7 and 4.4±0.6 cm; P=0.13). In subjects with DMR, all MV annular geometry-defining values were not significantly altered after TMVR (n=36; P>0.05). Acute anterior-posterior diameter reduction was associated with clinical response to TMVR after 6 months of follow-up (cutoff value, ≥6.4%; area under the curve, 0.81; P=0.002; sensitivity, 81.6%; specificity, 81.8%), which was confirmed by additional regression analysis (P=0.007). Conclusions-Three-dimensional transesophageal echocardiography enables assessment of acute changes of MV geometry in patients undergoing the MitraClip procedure. Only patients with functional mitral regurgitation experienced significant reduction of MV annular dimensions, which was associated with clinical response to TMVR. (Circ Cardiovasc Interv. 2014;7:390-399.) Methods and Results-Consecutive

The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation

“…In a previous study, it has been shown that reduction in AP diameter was not statistically significant in functional MR group. 16 On the other hand, Schueler et al 17 circumference is about 100 mm, 19 and the mean pre-clip annular circumference for all of our patients was about 130 mm, slightly larger for the degenerative group and slightly smaller for the functional group ( Figure 2). All patients had some degree of annular dilation (considering the upper limit of normal at 107 mm).…”

“…In a previous study, it has been shown that reduction in AP diameter was not statistically significant in functional MR group . On the other hand, Schueler et al has reported significant changes in all diameters with the exception of the bicommissural diameter in functional MR stating a positive clinical course. The same study revealed no difference in the degenerative group.…”

“…[6][7][8][9] To improve patient selection and outcomes for percutaneous treatment of functional and degenerative MR, it is critical to understand how the procedure achieves reductions in MR severity, and although several studies have described the use of transesophageal echocardiography for selecting and guiding percutaneous mitral valve repair using the MitraClip ® , [10][11][12] few studies have characterized the threedimensional anatomic characteristics of the mitral annulus 13,14 or evaluated the acute effects of the MitraClip ® device on the morphology and size of the mitral annulus. [15][16][17] The effects of edge-to-edge percutaneous mitral valve repair on the 3D structure and size of the mitral annulus and their relation to MR reduction we feel needs additional characterization. The aim of this investigation was to evaluate the acute morphologic changes that develop in the mitral annulus shape and dimensions and whether such changes mitigate MR severity after the MitraClip ® procedure in patients with functional and degenerative MR.…”

Role of modern 3D echocardiography in valvular heart disease

“…In the catheterization laboratory, 3D TEE can assist the positioning of the clip on the MV orifice, grasping of both MV leaflets, and evaluating the result, including visualization of the residual MR (Fig. 5) [60,61,62,63]. At the author's institution, 3D TEE is indispensable for the success of this procedure.…”

What to Do About Ischemic Mitral Regurgitation?

“…In terms of mechanism, the mitral clip might prove useful in functional MR by targeting the distorted annulus associated with this condition. In fact, the mitral clip has been shown to reduce mitral annular dimensions in functional MR, and this is associated with clinical improvement(12…”