Left atrial hemodynamics and left ventricular remodeling –predictors of outcomes after Transcatheter mitral valve repair with the MitraClip device

Abstract

Background Increased afterload and reduced left ventricular (LV) performance are sequela of mitral valve repair. However, hemodynamic left atrial and ventricular parameters that can predict outcome following mitral valve repair remain elusive. Methods One hundred and two consecutive patients undergoing MitraClip procedure from 2014 to 2017 at Banner University Medical Center were enrolled in this study. All patients underwent pre‐procedure echocardiograms and intra‐procedure invasive left atrial (LA) pressure monitoring. Clinical, laboratory, and procedural parameters were collected. The primary end‐point was the composite outcome of all‐cause mortality and repeat hospitalization within 90 days. Results The mean age was 77 ±10 years, the majority were Caucasians (93, 91.2%) and 47 (46.1%) were males. Thirty‐two patients (31.4%) had diabetes, 39 (38.2%) had renal insufficiency, and 38 (37.3%) had a history of congestive heart failure. The median society of thoracic surgeons score was 6.7% (Interquartile range [IQR]: 3.9, 10.2). Immediately post‐procedure there was a significant reduction in the LA pressure (Mean 12.0 vs. 18.6 mmHg, P < 0.001) and pulmonary artery systolic pressure (43.5 vs. 53.2 mmHg, P = 0.001) compared to baseline. LA pressure was an independent predictor of the composite outcome in an unadjusted (OR = 1.07, 95% CI: 1.00–1.13, P = 0.03) and adjusted (OR = 1.07, 95% CI: 1.00–1.14, P = 0.03) analysis respectively. Conclusion LA pressure drop is an independent predictor of outcome after the MitraClip procedure. This finding has implications for early identification of patients at risk of poor outcomes and instituting aggressive medical therapy and close follow‐up for avoiding hospitalizations for heart failure decompensation.

Should the mean left atrial pressure be the ultimate goal after TMVR?

“…MLAP was found to be an independent predictor of clinical outcomes following TMVR at 90 days. In our experience during EVEREST trials, immediate reduction up to 50% were noted in both MLAP as well as height of the V wave following some of our successful TMR procedures 2,5 . Considering MLAP to be one of the best predictors of prognosis in patients both with diastolic and systolic heart failure, these findings should not be a surprise.…”

“…In our experience during EVEREST trials, immediate reduction up to 50% were noted in both MLAP as well as height of the V wave following some of our successful TMR procedures. 2,5 Considering MLAP to be one of the best predictors of prognosis in patients both with diastolic and systolic heart failure, these findings should not be a surprise. New generation Mitraclip system also allows continuous monitoring of the MLAP during the procedure.…”

Hemodynamics rounds: Hemodynamics of mitral valve interventions

“…As suggested by previous study, continuous invasive hemodynamic assessment enhances this reduction; accounts for intraprocedural changes in intravascular volume and pressure; and parallels a concomitant improvement in pulmonary artery pressures, vascular resistance, and cardiac index . In turn, this improvement correlates with clinical outcomes, including symptom class, 6‐minute walk, need for future surgical intervention, recurrent hospitalization for heart failure, and all‐cause mortality …”

Hemodynamics in mitral regurgitation – before and after correction with MitraClip

“…Редица проучвания доказват прогностична стойност на спада в левопредсърдните налягания не само по отношение на смърт, но и по отношение необходимост от реоперация и рехоспитализация поради прогресия на сърдечната недостатъчност [17,18] (табл. 3).…”