Effects of Mitral Annulus Remodeling Following MitraClip Procedure on Reduction of Functional Mitral Regurgitation

Hidalgo, F.; Mesa, Dolores; Ruiz, Martín; Delgado, Mónica; Rodríguez, Sara; Pardo, Laura; Pan, Manuel; López, Amador; Romero, Miguel; Lezo, José Suárez de

doi:10.1016/j.rec.2016.04.003

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…[40, 41] On the other hand, Hidalgo et al found that 41% in patients with FMR undergoing MitraClip had an MR jet in the A2P2 region and 45.5% had a jet that spanned the A2P2- A3P3 region. [37] This supports the contention that postero-lateral MI is associated with leaflet restriction along the entire A2P2 A3P3 section rather than at A2P2 or A3P3 separately. Location of the virtual MitraClip at A2P2 in the current study is therefore reasonable.…”

Section: Discussionsupporting

confidence: 70%

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

et al. 2019

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PurposeMitraClip is the sole percutaneous device approved for functional mitral regurgitation (MR; FMR) but MR recurs in over one third of patients. As device-induced mechanical effects are a potential cause for MR recurrence, we tested the hypothesis that MitraClip increases leaflet stress and procedure-related strain in sub-valvular left ventricular (LV) myocardium in FMR associated with coronary disease (FMR-CAD).MethodsSimulations were performed using finite element models of the LV + mitral valve based on MRI of 5 sheep with FMR-CAD. Models were modified to have a 20% increase in LV volume (↑LV_VOLUME) and MitraClip was simulated with contracting beam elements (virtual sutures) placed between nodes in the center edge of the anterior (AL) and posterior (PL) mitral leaflets. Effects of MitraClip on leaflet stress in the peri-MitraClip region of AL and PL, septo-lateral annular diameter (SLAD), and procedure-related radial strain (Err) in the sub-valvular myocardium were calculated.ResultsMitraClip increased peri-MitraClip leaflet stress at end-diastole (ED) by 22.3±7.1 kPa (p<0.0001) in AL and 14.8±1.2 kPa (p<0.0001) in PL. MitraClip decreased SLAD by 6.1±2.2 mm (p<0.0001) and increased Err in the sub-valvular lateral LV myocardium at ED by 0.09±0.04 (p<0.0001)). Furthermore, MitraClip in ↑LV_VOLUME was associated with persistent effects at ED but also at end-systole where peri-MitraClip leaflet stress was increased in AL by 31.9±14.4 kPa (p = 0.0268) and in PL by 22.5±23.7 kPa (p = 0.0101).ConclusionsMitraClip for FMR-CAD increases mitral leaflet stress and radial strain in LV sub-valvular myocardium. Mechanical effects of MitraClip are augmented by LV enlargement.

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Section: Discussionsupporting

confidence: 70%

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

et al. 2019

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“…Similar to other studies published, 8,9 it has been observed a significant reduction of the anteroposterior diameter after the implant. However, unlike Remy et al 9 describe in patients with functional MR, there was a greater relative reduction of the anteroposterior diameter and a non-significant tendency to a greater reduction of these patients' area Also, in our series, we saw a reduction of the intercomissural diameter, which may have to do with a significant and sudden reduction of the regurgitation volume and with left intra-articular pressure, rather than with a direct mechanical effect coming from the clip.…”

Section: Discussionsupporting

confidence: 90%

“…[5][6][7] This procedure is thought to be able to operate changes in the anatomy of the mitral annulus beyond the edge-to-edge approach of the valvular leaflets, but there is very little information on this regard. Some studies speak about a significant change of anteroposterior diameters in RM of functional etiology 8 while others describe changes of diameter, in non-constant areas and in etiologydependent areas. 9 The goal of this study is to analyze the morphological changes occurring in the mitral valve after the TMVR and its relation to the degree of reduction of MR in the short and mid-terms, and its association with the clinical goals.…”

Section: Introductionmentioning

confidence: 99%

Changes in mitral annular morphology following transcatheter mitral valve repair. Clinical repercussion and importance of etiology

Alperi¹,

Pascual²,

Argüero³

et al. 2019

RECICE

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Introduction and objectives:Mitral regurgitation is one society's most prevalent valvular diseases. Transcatheter mitral valve repair with the MitraClip system has become more widely used for the management of this condition. The endpoints of the study were the changes in the mitral annular morphology, the recurrent grade III-IV mitral valve regurgitation, and a composite endpoint of heart failure readmission and all-cause mortality. Methods: Single-centre, prospective and observational study. We included patients admitted due to transcatheter mitral valve repair between October 2015 and October 2018. The three-dimensional analysis of the mitral valve annulus was performed using the MVQ QLAB mitral valve quantification software (Philips; Amsterdam, The Netherlands). Results: Fifty procedures were performed on 48 patients. A significant decrease of both annular diameters, perimeter and area was observed after the procedure. The antero-posterior diameter reduction was more significant in patients with functional mitral regurgitation compared to patients with organic mitral regurgitation (13.2 ± 8.8 vs 8.6 ± 7.5; P = .05). The posterior leaflet grasping was the only parameter associated with less chances of significant recurrent mitral regurgitation (OR = 0.89; 95CI%, 0.79-0.98). Conclusions: Mitral annular morphological changes occur after MitraClip implantation. The magnitude of these changes varies depending on the etiology of mitral regurgitation. Posterior leaflet grasping is the main factor associated with these changes and prevents the recurrence of significant mitral regurgitation. RESUMEN Introducción y objetivos:La insuficiencia mitral es una de las enfermedades valvulares más prevalentes en nuestro medio. La reparación mitral transcatéter con el sistema MitraClip es un procedimiento cada vez más utilizado en este contexto. Los objetivos del estudio fueron evaluar los cambios morfológicos anulares, la recurrencia de la insuficiencia mitral significativa y un objetivo combinado de reingreso por insuficiencia cardiaca y mortalidad global. Métodos: Estudio prospectivo, observacional y unicéntrico. Se incluyeron pacientes tratados con reparación mitral transcatéter entre octubre de 2015 y octubre de 2018. Se realizó un análisis tridimensional del anillo con el software de cuantificación mitral MVQ QLAB 10.0 (Philips; Amsterdam, Países Bajos). Resultados: Se realizaron 50 procedimientos en 48 pacientes. Tras el procedimiento se observó una disminución significativa de ambos diámetros anulares, así como del perímetro y del área, y una mayor reducción del diámetro anteroposterior en los pacientes con insuficiencia mitral funcional con respecto a aquellos con insuficiencia mitral orgánica (13,2 ± 8,8 frente a 8,6 ± 7,5; p = 0,05). El porcentaje de grasping sobre el velo posterior fue el único parámetro que se asoció estadísticamente a una menor probabilidad de desarrollar insuficiencia mitral significativa (OR = 0,89; IC95%, 0,79-0,98). Conclusiones: Tras el implante de MitraClip se producen cambios morfológicos e...

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“…[41,42] On the other hand, Hidalgo et al found that 41% in patients with FMR undergoing MitraClip had an MR jet in the A2P2 region and 45.5% had a jet that spanned the A2P2-A3P3 region. [38] This supports the contention that postero-lateral MI is associated with leaflet restriction along the entire A2P2 A3P3 section rather than at A2P2 or A3P3 separately. Location of the virtual MitraClip at A2P2 in the current study is therefore reasonable.…”

Section: Mitraclip Durabilitysupporting

confidence: 79%

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Zhang

Wang

Morgan

et al. 2019

Preprint

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Purpose: MitraClip is the sole percutaneous device approved for functional mitral regurgitation (MR; FMR) but MR recurs in over one third of patients. As device-induced mechanical effects are a potential cause for MR recurrence, we tested the hypothesis that MitraClip increases leaflet stress and procedure-related strain in sub-valvular left ventricular (LV) myocardium in FMR associated with coronary disease (FMR-CAD). Methods:Simulations were performed using finite element models of the LV + mitral valve based on MRI of 5 sheep with FMR-CAD. Models were modified to have a 20% increase in LV volume (↑LV_VOLUME) and MitraClip was simulated with contracting beam elements (virtual sutures) placed between nodes in the center edge of the anterior (AL) and posterior (PL) mitral leaflets. Effects of MitraClip on leaflet stress in the peri-MitraClip region of AL and PL, septo-lateral annular diameter (SLAD), and procedurerelated radial strain (Err) in the sub-valvular myocardium were calculated.Results: MitraClip increased peri-MitraClip leaflet stress at end-diastole (ED) by 22.3±7.1 kPa (p<0.0001) in AL and 14.8±1.2 kPa (p<0.0001) in PL. MitraClip decreased SLAD by 6.1±2.2 mm (p<0.0001) and increased Err in the sub-valvular lateral LV myocardium at ED by 0.09±0.04 (p<0.0001)). Furthermore, MitraClip in ↑LV_VOLUME was associated with persistent effects at ED but also at end-systole where peri-MitraClip leaflet stress was increased in AL by 31.9±14.4 kPa (p=0.0268) and in PL by 22.5±23.7 kPa (p=0.0101). Conclusions:MitraClip for FMR-CAD increases mitral leaflet stress and radial strain in LV sub-valvular myocardium. Mechanical effects of MitraClip are augmented by LV enlargement. Abstract Word Count:249 AL P2 Ao MClip A. B. C.

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Effects of Mitral Annulus Remodeling Following MitraClip Procedure on Reduction of Functional Mitral Regurgitation

Cited by 12 publications

References 29 publications

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Changes in mitral annular morphology following transcatheter mitral valve repair. Clinical repercussion and importance of etiology

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

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