Impact of mitral geometry and global afterload on improvement of mitral regurgitation after trans-catheter aortic valve implantation

Abstract

ObjectiveTo assess the impact of mitral geometry, left ventricular (LV) remodelling and global LV afterload on mitral regurgitation (MR) after trans-catheter aortic valve implantation (TAVI).MethodsIn this study, 60 patients who underwent TAVI were evaluated by 3D echocardiography at baseline, 1 month and 6 months after procedure. The proportional change in MR following TAVI was determined by examining the percentage change in vena contracta (VC) at 6 months. Patients having a significant reduction of at least 30% in VC were defined as good responders (GR) and the remaining patients were defined as poor responders (PR).ResultsAfter 6 months of TAVI, 27 (45%) patients were GR and 33 (55%) were PR. There was a significant decrease in 3DE-derived mitral annular diameter and area (P = 0.001), mitral valve tenting area (TA) (P = 0.05), and mitral papillary muscle dyssynchrony index (DSI) (P = 0.05) in the GR group. 3DE-derived LVESV (P = 0.016), LV mass (P = 0.001) and LV DSI, (P = 0.001) were also improved 6 months after TAVI. In addition, valvulo-arterial impedance (ZVA) was significantly higher at baseline in patients with PR (P = 0.028). 3DE-derived mitral annular area (β: 0.47, P = 0.04), mitral papillary DSI (β: −0.65, P = 0.012) and ZVA (β: 0.45, P = 0.028) were the strongest independent parameters that could predict the reduction of functional MR after TAVI.ConclusionGR patients demonstrate more regression in mitral annulus area and diameter after significant decrease in high LVEDP and trans-aortic gradients with TAVI. PR patients appear to have increased baseline ZVA, mitral valve tenting and restriction in mitral valve coaptation. These factors are important for predicting the impact of TAVI on pre-existing MR.

Mechanisms and implications of mitral regurgitation in patients with severe aortic stenosis who received transcatheter aortic valve replacement

“…We conducted detailed analyses of MR Several investigators reported that the frequency of improvement in preexisting MR after TAVR was 30%−50%. [1][2][3][4][5][6][7][8][9] Our study was concordant with those studies but exhibited one of the highest rates of MR improvement. Probably, this high recovery rate of MR may be related to the afterload dependency of MR volume at the baseline in this study.…”

“…19 We calculated the Zva = (SAP + MG)/stroke volume index, where SAP is the systolic arterial pressure and MG is the mean transvalvular pressure gradient, as previously described. 7 ESWS contains a component of LV geometrical adaptation to the afterload, which Zva does not have. The Chi-squared test was used for categorical variables.…”

Assessment of mitral regurgitation and mitral complex geometry in patients after transcatheter aortic valve implantation

“…Both mentioned components of functional MR led to mitral apparatus geometry deformation, including leaflet restriction, enlargement of the mitral ring, and increase in distance between papillary muscles. Considering the complexity of the MR pathomechanism in patients with AS and improvement of left ventricular function after TAVI, a reduction in the significance of MR after the procedure should be expected [ 16 ].…”

“…also showed the importance of mitral annulus diameter and area reduction (2D and 3D analysis) in the group with MR improvement. Moreover, they observed no effect of TAVI on MR in the group with restriction of mitral leaflets, which is a consequence of mitral complex geometry change, as the greater distance between papillary muscles [ 16 ]. In our study, a significant decrease of sPAP was observed, although it may be the result of aortic valve implantation as well as a decrease in the significance of MR.…”

Άμεσες Και Απώτερες Επιπτώσεις Που Παρατηρούνται Σε Ασθενείς Με Βαλβιδική Ανεπάρκεια Ή Παραβαλβιδική Διαφυγή Μετά Από Διαδερμική Εμφύτευση Αορτικής Βαλβίδας

“…Επιπλέον, άλλες μελέτες αναφέρουν ότι επιπλοκές όπως η εμφύτευση μόνιμου βηματοδότη συνεπεία πλήρους κολποκοιλιακού αποκλεισμού 123 και ο υψηλός βαθμός παραβαλβιδικής διαφυγής 124 αποτελούν σημαντικούς προγνωστικούς παράγοντες ελαττωμένου ΚΕΑΚ μετεπεμβατικά.Σχετικά με τα δημογραφικά χαρακτηριστικά της παρούσας μελέτης, η μέση ηλικία των ασθενών του δείγματός μας (81,8 έτη) φάνηκε πως είναι απολύτως συγκρίσιμη με πολλές μελέτες από την υπάρχουσα βιβλιογραφία 99,107,[125][126][127]. Τέλος, οι γυναίκες αποτέλεσαν την πλειοψηφία του δείγματος (56%) εύρημα που βρίσκεται σε συμφωνία με τα υπάρχοντα βιβλιογραφικά δεδομένα,99,105,106,127,128 με ελάχιστες εξαιρέσεις,112,129,130 όπου η αναλογία των ανδρών είναι μεγαλύτερη εκείνης των γυναικών. TAVI μέσω της διαμηριαίας οδού 58.…”