Improved mitral valve coaptation and reduced mitral valve annular size after percutaneous mitral valve repair (PMVR) using the MitraClip system

Patzelt, Johannes; Zhang, Yingying; Magunia, Harry; Ulrich, Miriam; Jorbenadze, Rezo; Droppa, Michal; Zhang, Wenzhong; Lausberg, Henning; Walker, Tobias; Rosenberger, Peter; Seizer, Peter; Gawaz, Meinrad; Langer, Harald F.

doi:10.1093/ehjci/jex173

Cited by 18 publications

(21 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Atrial enlargement has been found to be an independent predictor for onset of AF after mitral valve repair, with atrial remodeling being the major culprit of electrical instability and susceptibility for AF . We and others have observed that PMVR results in significant geometrical changes, especially of the left atrium . On the cellular level, Foglieni et al have shown enhanced cardiomyocyte hypertrophy and higher intracytoplasm cytochrome c levels, as well as increased myocardial fibrosis in atria of patients with severe MR, illustrating the substrate changes that occur with prolonged atrial strain .…”

Section: Discussionmentioning

confidence: 65%

“…9 We and others have observed that PMVR results in significant geometrical changes, especially of the left atrium. 3 Study participants for increased P wave duration and PR interval. 19 Furthermore, a decrease of P wave amplitude is associated with lower recurrence rates after cryoballoon ablation of AF.…”

Section: Discussionmentioning

confidence: 99%

“…While a reduction of MR has obvious hemodynamical advantages by increasing the effective left ventricular stroke volume and cardiac output, other secondary effects have been described. In a previous study, we have found that improved mitral valve coaptation and improved mitral valve annular size correlates with residual MR after PMVR using the MitraClip system . Furthermore, a recent study has found a significant decrease in left atrial operating chamber stiffness after deployment of PMVR .…”

Section: Introductionmentioning

confidence: 90%

“…In a previous study, we have found that improved mitral valve coaptation and improved mitral valve annular size correlates with residual MR after PMVR using the MitraClip system. 3 Furthermore, a recent study has found a significant decrease in left atrial operating chamber stiffness after deployment of PMVR. 4 Increased strain of the left atrium through MR induces a significant remodeling of the affected atrial myocardium, which is an ideal substrate for atrial rhythm disturbances, especially atrial fibrillation (AF).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

ECG changes after percutaneous edge‐to‐edge mitral valve repair

Hou

Heinzmann

Grasshoff

et al. 2019

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Background Mitral regurgitation (MR) has a severe impact on hemodynamics and induces severe structural changes in the left atrium. Atrial remodeling is known to alter excitability and conduction in the atrium facilitating atrial fibrillation and atrial flutter. PMVR is a feasible and highly effective procedure to reduce MR in high‐risk patients, which are likely to suffer from atrial rhythm disturbances. So far, electroanatomical changes after PMVR have not been studied. Hypothesis In the current study, we investigated changes in surface electrocardiograms (ECGs) of patients undergoing PMVR for reduction of MR. Methods We evaluated 104 surface ECGs from patients in sinus rhythm undergoing PMVR. P wave duration, P wave amplitude, PR interval, QRS duration, QRS axis, and QT interval were evaluated before and after PMVR and at follow‐up. Results We found no changes in QRS duration, QRS axis, and QT interval after successful PMVR. However, P wave duration, amplitude, and PR interval were significantly decreased after reduction of MR through PMVR (P < .05, respectively). Conclusion The data we provide offers insight into changes in atrial conduction after reduction of MR using PMVR in patients with sinus rhythm.

show abstract

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

ECG changes after percutaneous edge‐to‐edge mitral valve repair

Hou

Heinzmann

Grasshoff

et al. 2019

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…With respect to PMVR, positive 5-year-outcome results were published recently, showing an increased rate of relapsing MR after one year compared to surgery, while beyond 1 year there was no difference compared to surgery [ 2 ], implying good stabilization of mitral ring geometry with PMVR. In line with these data, positive remodeling of the LV geometry with a reduction of the mitral valve anterior-posterior diameter immediately after the procedure was documented, which remained stable over time and was even more pronounced at follow-up [ 3 ]. To achieve this positive remodeling and to maintain permanent reduction of MR, the MitraClip needs to catch sufficient material of the anterior and posterior mitral valve leaflets, when the grasping maneuver is performed.…”

Section: Introductionmentioning

confidence: 76%

Previous TAVR in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR) affects improvement of MR

Patzelt¹,

Ulrich²,

Becker³

et al. 2018

PLoS ONE

Self Cite

View full text Add to dashboard Cite

BackgroundPatients after transcatheter aortic valve replacement (TAVR) and persistent severe mitral regurgitation (MR) are increasingly treated with percutaneous edge-to-edge mitral valve repair (PMVR). The impact of a former TAVR on PMVR procedures is not clear.Methods and resultsWe retrospectively analyzed 332 patients undergoing PMVR using the MitraClip system with respect to procedural and clinical outcome. 21 of these 332 patients underwent TAVR before PMVR. Intra-procedural transthoracic (TTE) and transesophageal echocardiograms (TEE) immediately before and after clip implantation as well as invasive hemodynamic measurements were evaluated. At baseline, we found a significantly smaller mitral valve anterior-posterior diameter in the TAVR cohort (p < 0.001). A reduction of MR by at least three grades was achieved in a smaller fraction in the TAVR cohort as compared to the cohort with a native aortic valve (p = 0.02). Accordingly, we observed a smaller post-procedural cardiac output in the TAVR cohort (p = 0.02).ConclusionPMVR in patients who had a TAVR before, is associated with altered MR anatomy before and a reduced improvement of MR after the procedure. Future larger and prospective studies will have to determine, whether a previous TAVR influences long-term clinical outcome of patients undergoing PMVR.

show abstract

Effect of a novel transcatheter edge‐to‐edge repair device on the three‐dimensional geometry of mitral valve in degenerative mitral regurgitation

Pan

Zhou

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives: We sought to assess the acute intraprocedural effects of the ValveClamp system in DMR patients on the mitral valve (MV) three-dimensional (3D) geometry and the association of these effects with mitral regurgitation (MR) reduction. Background: Few data are available about the specific impact of transcatheter edgeto-edge repair in patients with degenerative mitral regurgitation (DMR). Methods: Thirty-five symptomatic patients (age 74.26 ± 6.61 years) with Grade 3 to 4+ degenerative MR underwent 3D transoesophageal echocardiography (TEE) during ValveClamp implantation. Volumetric data sets were retrospectively analyzed using mitral valve quantitative 3D modeling software. Results: Mitral valve annular anterior-posterior (AP) diameter decreased from 33.24 ± 4.03 to 31.12 ± 3.66 mm (p < .001), and prolapse height from 4.78 ± 2.19 to 2.32 ± 1.92 mm (p < .001), and total exposed leaflet area from 1,110.29 ± 224.21 mm 2 to 1,013.44 ± 228.71 mm (p = .004). Accordingly, we observed a significant reduction of MR severity after ValveClamp implantation. Multivariable analysis revealed postprocedural MR reduction was associated with shortening in anterior-posterior diameter (coefficient 0.427, p = .008) and reduction in prolapse height (coefficient 0.369, p = .021). Conclusions: ValveClamp implantation exerts an acute effect on the 3D MV geometry. Postprocedural reduction in AP diameter and reduction in prolapse height correlates with MR downgrading in patients with degenerative MR.

show abstract

Improved mitral valve coaptation and reduced mitral valve annular size after percutaneous mitral valve repair (PMVR) using the MitraClip system

Abstract: This study demonstrates mechanical approximation of both mitral valve annulus edges with improved mitral valve annular coaptation by PMVR using the MitraClip® system, which correlates with residual MR in patients with MR.

Cited by 18 publications

References 25 publications

ECG changes after percutaneous edge‐to‐edge mitral valve repair

ECG changes after percutaneous edge‐to‐edge mitral valve repair

Previous TAVR in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR) affects improvement of MR

Effect of a novel transcatheter edge‐to‐edge repair device on the three‐dimensional geometry of mitral valve in degenerative mitral regurgitation

Contact Info

Product

Resources

About