Elevated Mitral Valve Pressure Gradient Is Predictive of Long‐Term Outcome After Percutaneous Edge‐to‐Edge Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation (MR), But Not in Functional MR

Abstract

Background This study analyzed the effects on long‐term outcome of residual mitral regurgitation ( MR ) and mean mitral valve pressure gradient ( MVPG ) after percutaneous edge‐to‐edge mitral valve repair using the MitraClip system. Methods and Results Two hundred fifty‐five patients who underwent percutaneous edge‐to‐edge mitral valve repair were analyzed. Kaplan–Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical end point (all‐cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used. After percutaneous edge‐to‐edge mitral valve repair, mean MVPG increased from 1.6±1.0 to 3.1±1.5 mm Hg ( P <0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive of the combined end point while elevated MVPG >4.4 mm Hg was not according to Kaplan–Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities. In the cohort with degenerative MR , elevated MVPG was associated with increased occurrence of the primary end point, whereas this was not observed in the cohort with functional MR . Conclusions MVPG >4.4 mm Hg after MitraClip implantation was predictive of clinical outcome in the patient cohort with degenerative MR . In the patient cohort with functional MR , MVPG >4.4 mm Hg was not associated with increased clinical events.

30‐day patient reported outcomes can be predicted by change in left atrial pressure and not change in transmitral gradient following MitraClip

“…A recent study by Patzelt et al, evaluated the impact of postprocedural MG on outcomes. They found that a MG cutoff of 4.4 mmHg was predictive of outcomes in patients with degenerative MR but not in functional MR 9 …”

“…A recent study by Patzelt et al, evaluated the impact of postprocedural MG on outcomes. They found that a MG cutoff of 4.4 mmHg was predictive of outcomes in patients with degenerative MR but not in functional MR 9. The correlation between MG and LAP in relation to symptomatic improvement post-MitraClip is less established.…”

Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation

“…Elevated mitral valve pressure gradient might increase left atrial pressure, of which the latter is associated with less improvement in 6MWD after MitraClip implantation [33]. A recent trial on MitraClip therapy for secondary MR did not show a correlation between postprocedural mitral valve pressure gradient and 6MWD, but with worse NYHA class [34]. Therefore, elevated mitral valve pressure gradient in women might be an important factor in the observed gender-specific difference.…”

Review: application of current imaging modalities in the management of left-sided valvular heart disease

“…In MR, assessment of the valve, left ventricle, left atrium, chordae tendineae and papillary muscles are all important to determine the etiology of the disease. It is also crucial to determine the type of MR (primary or secondary, ischemic or nonischemic) due to the differences in treatment options and post-procedural prognosis (31)(32)(33). Past reports have suggested that successful repair for secondary MR was less likely in the presence of mitral valve (MV) deformation, global LV remodeling and local LV remodeling (34).…”