Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair

Itabashi, Yuji; Utsunomiya, Hiroto; Kubo, Shunsuke; Mizutani, Yukiko; Mihara, Hirotsugu; Murata, Mitsushige; Siegel, Robert J.; Kar, Saibal; Fukuda, Keiichi; Shiota, Takahiro

doi:10.1016/j.jjcc.2017.10.023

Cited by 19 publications

(9 citation statements)

References 29 publications

(44 reference statements)

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“…Itabashi et al 23 showed that increased LV and MV dimensions might be accountable for a somewhat lower intraprocedural MG in a comparable cohort after one‐clip implantation. Contrary to our findings, patients with FMR showed a tendency for developing higher intraprocedural MG in this study, which might be due to smaller annular dimensions in their study cohort (AP diameter: 32 vs 38 mm).…”

Section: Discussionmentioning

confidence: 98%

The predictive value of intraprocedural mitral gradient for outcomes after MitraClip and its peri‐interventional dynamics

et al. 2021

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Background The current data on the impact of the increased mitral gradient (MG) on outcomes are ambiguous, and intraprocedural assessment of MG can be challenging. Therefore, we aimed to evaluate (a) peri‐interventional dynamics of MG, (b) the impact of intraprocedural MG on clinical outcomes, and (c) predictors for unfavorable MG values after MitraClip. Methods We prospectively included patients who underwent MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after 6 months. 12‐month survival was documented. Results One hundred and seventy five patients (age 81.2 ± 8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups according to intraprocedural MG with a threshold of 4.5 mm Hg, determined by a multivariate analysis of predictors for 12‐month mortality (<4.5 mm Hg: Group 1, ≥4.5 mm Hg: Group 2). Intraprocedural MG ≥4.5 mm Hg was found to be the strongest independent predictor for 12‐month mortality (HR: 2.33, P = .03, OR: 1.70, P = .05), and >3.9 mm Hg was associated with adverse functional outcomes (OR: 1.96, P = .04). The baseline leaflet‐to‐annulus index >1.1 was found to be the strongest independent predictor (OR: 9.74, P = .001) for unfavorable intraprocedural MG, followed by the number of implanted clips (P = .01), MG at baseline (P = .02), and central clip implantation (P = .05). Conclusion An intraprocedural MG <3.9 mm Hg appears to be the best strategy for 1‐year survival and favorable functional outcomes after edge‐to‐edge MV repair with MitraClip independently from MR etiology. Peri‐interventional echocardiographic and procedural parameters are useful for the adequate assessment of intraprocedural MG.

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Section: Discussionmentioning

confidence: 98%

The predictive value of intraprocedural mitral gradient for outcomes after MitraClip and its peri‐interventional dynamics

et al. 2021

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“…Two predictors of a MV mean PG ≤ 4 mmHg after clip deployment in PMR were preprocedural mitral valve opening area of (MVOA) ≥ 3.94 cm² and medial-lateral diameter of left ventricle (LV) inflow orifice ≥ 3.23 cm for patients receiving one implanted clip. In case of two clips, cut-offs were 4.82 cm² and 3.29 cm, respectively [38] .…”

Section: Pmr Only Collectivementioning

confidence: 99%

“…Comparable to PMR, preprocedural MVOA and medial-lateral diameter of LV inflow orifice can also predict postprocedural mitral stenosis. For one and two clips, the cut-off values were 3.77 cm²/5.05 cm² and 3.03 cm/3.39 cm, respectively [38] .…”

Section: Smr Only Collectivementioning

confidence: 99%

Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

Stolz¹,

Orban²,

Braun³

et al. 2020

Mini-invasive Surg

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“…[8][9][10][11] Occasionally, the chance of producing a relevant MS following the implantation of 2 or more clips is not negligible. Patients expected to develop this complication can be identified in advance by echocardiography on the basis of the initial valve area 12 and the intercommissural jet extension/location. In these patients, the target should be maximal reduction of MR and minimal increase of gradient across the valve.…”

mentioning

confidence: 99%

Commentary: Between Scylla and Charybdis

Denti

Buzzatti

Alfieri

2022

The Journal of Thoracic and Cardiovascular Surgery

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Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair

Abstract: 3D TEE derived MVOA predicts the postprocedural MS after 1-clip implantation, however, preprocedural ML diameter of LV inflow orifice is more useful to predict after 2-clip implantation.

Cited by 19 publications

References 29 publications

The predictive value of intraprocedural mitral gradient for outcomes after MitraClip and its peri‐interventional dynamics

The predictive value of intraprocedural mitral gradient for outcomes after MitraClip and its peri‐interventional dynamics

Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

Commentary: Between Scylla and Charybdis

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