Changes in dynamic mitral valve geometry during percutaneous edge–edge mitral valve repair with the MitraClip system

Noack, Thilo; Kiefer, Philipp; Mallon, Linda; Lurz, Philipp; Bevilacqua, Carmine; Banusch, J.; Emrich, Fabian; Holzhey, David; Vannan, Mani A.; Thiele, Holger; Mohr, Friedrich–Wilhelm; Borger, Michael A.; Ender, Joerg

doi:10.1007/s12574-018-0398-0

Cited by 14 publications

(22 citation statements)

References 29 publications

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“…The acute effects of MitraClip on MV geometry under functional MR have been investigated in a few clinical studies using echo (Schmidt et al, 2013;Schueler et al, 2014;Noack et al, 2019b). Similar to these investigations, we found a marked reduction of the AP distance together with a relatively small increase of the AL-PM distance, especially when a ring was added (Table 1).…”

Section: Effects On MV Geometrysupporting

confidence: 83%

A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

et al. 2020

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Percutaneous edge-to-edge mitral valve (MV) repair using MitraClip has been recently established as a treatment option for patients with heart failure and functional mitral regurgitation (MR), which significantly expands the number of patients that can be treated with this device. This study aimed to quantify the morphologic, hemodynamic and structural changes, and evaluate the biomechanical interaction between the MitraClip and the left heart (LH) complex of a heart failure patient with functional MR using a fluid-structure interaction (FSI) modeling framework. MitraClip implantation using lateral, central and double clip positions, as well as combined annuloplasty procedures were simulated in a patient-specific LH model that integrates detailed anatomic structures, incorporates age-and gender-matched non-linear elastic material properties, and accounts for mitral chordae tethering. Our results showed that anteroposterior distance, mitral annulus spherecity index, anatomic regurgitant orifice area, and anatomic opening orifice area decreased by up to 28, 39, 52, and 71%, respectively, when compared to the pre-clip model. MitraClip implantation immediately decreased the MR severity and improved the hemodynamic profile, but imposed a non-physiologic configuration and loading on the mitral apparatus, with anterior and posterior leaflet stress significantly increasing up to 210 and 145% during diastole, respectively. For this patient case, while implanting a combined central clip and ring resulted in the highest reduction in the regurgitant volume (46%), this configuration also led to mitral stenosis. Patient-specific computer simulations as used here can be a powerful tool to examine the complex device-host biomechanical interaction, and may be useful to guide device positioning for potential favorable clinical outcomes.

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Section: Effects On MV Geometrysupporting

confidence: 83%

A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

et al. 2020

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“…Such data about annular dynamics after MitraClip procedure are lacking in previous reports. 5,8 In particular Noak et al 10 have previously addressed the evaluation of AHCWR changes, with specific reference to the FMR cohort, but failed in recording any significant variation in the acute intra-procedural setting. Besides the use of newer devices, a possible explanation could be found in the higher percentage of clip implanted in our patients (> 1 clip implanted: 54.5% vs 32%).…”

Section: Fmr Cohortmentioning

confidence: 99%

Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT_R by three‐dimensional echocardiography

et al. 2021

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Background: Mitral valve (MV) repair with MitraClip system is a safe treatment option for high-risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three-dimensional echocardiography (3D-E), changes occurring in MV after implantation of third generation MitraClip XT R device, with specific reference to the underlying MR mechanism (functional vs degenerative, FMR vs DMR). Methods:We prospectively enrolled 59 patients, who underwent intra-procedural 3D-E before and after device deployment. Three-D datasets were analyzed off-line, using a dedicated semiautomatic software, to obtain parametric quantification of mitral anatomy.Results: Post-procedural MR of mild or lesser degree was achieved in 40 patients (68%), with no differences between FMR and DMR (p 0.9). After MitraClip XT R implantation, the FMR group experienced an immediate annular resizing, with reduction of antero-posterior diameter (p 0.024) and sphericity index (p 0.017), next to a recovery of physiological saddle-shape, defined by lower non-planar angle (p ≤0.001) and higher annulus height to commissural width ratio (p ≤0.001). On the opposite, the DMR group revealed a significant decrease of maximum annular velocity (p 0.027), addressing a mechanic effect of the device deployment. Finally, baseline anterior mitral leaflet angle was found as an independent predictor of acute procedural result (OR 6.7,], p 0.049). Conclusions:MitraClip XT R implantation acts in restoring the original mitral geometry, with distinctive effects according to MR mechanism. Three-D parametric quantification of MV sheds new light on changes occurring in the valvular apparatus, and helps identifying possible new predictors of acute procedural success.

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“…Remy et al reported anteroposterior diameter reduction in the overall cohort, whereas only organic MR patients experienced a significant decrease regarding valve area (10). Other studies conducted exclusively in functional MR valves demonstrated a significant reduction in anteroposterior diameter (10,(15)(16)(17). A recently published analysis of 60 clip recipients showed significant overall reduction in both diameter and perimeter, without differences between etiologies (16).…”

Section: Discussionmentioning

confidence: 97%

Functional mitral regurgitation: structural modifications with percutaneous valve repair with MitraClip

et al. 2020

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Background: Mitral regurgitation (MR) is one of the most prevalent valvular diseases in our society.Transcatheter mitral valve repair (TMVR) with the MitraClip ® system is increasingly used for treating this condition. The aim of our study is to analyse morphological mitral valve changes related to the procedure and its correlation with the degree of regurgitation at mid-term follow-up and with the combined endpoint of heart failure and all-cause mortality.Methods: A single-centre, prospective and observational study including consecutive patients admitted between October 2015 and October 2019 for TMVR was designed. The mitral valve annulus (MVA) was analyzed using the three-dimensional MVQ QLAB mitral valve quantification software (Philips; Amsterdam, The Netherlands). Clinical data was collected retrospectively.Results: Eighty-two MitraClip ® were implanted. Control echocardiograms showed a significant decrease in the three measures: annular diameters, perimeter and area. Patients with functional MR had greater left ventricular and mitral annular dimensions and experienced greater reductions in anteroposterior diameter and mitral valve area compared with organic MR patients. The anteroposterior diameter reduction (OR 0.90; 95% CI: 0.82-0.99), as well as posterior leaflet grasping (OR 0.94; 95% CI: 0.89-0.99) were associated with the probability of significant MR recurrence. Posterior leaflet grasping and left ventricle ejection fraction were associated with the combined endpoint of heart failure and any cause death.Conclusions: MitraClip ® implantation results in secondary changes in the mitral annular morphology. The magnitude of these morphological changes varies depending on the etiology of the mitral valve regurgitation.Posterior leaflet grasping and anteroposterior diameter reduction after clip are factors associated with relevant clinical and echocardiographic endpoints.

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Changes in dynamic mitral valve geometry during percutaneous edge–edge mitral valve repair with the MitraClip system

Cited by 14 publications

References 29 publications

A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT_R by three‐dimensional echocardiography

Functional mitral regurgitation: structural modifications with percutaneous valve repair with MitraClip

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Changes in dynamic mitral valve geometry during percutaneous edge–edge mitral valve repair with the MitraClip system

Cited by 14 publications

References 29 publications

A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XTR by three‐dimensional echocardiography

Functional mitral regurgitation: structural modifications with percutaneous valve repair with MitraClip

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Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT_R by three‐dimensional echocardiography