Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair

Koell, Benedikt; Ludwig, Sebastian; Weimann, Jessica; Waldschmidt, Lara; Hildebrandt, Annabel; Schofer, Niklas; Schirmer, Johannes; Westermann, Dirk; Reichenspurner, Hermann; Blankenberg, Stefan; Conradi, Lenard; Lubos, Edith; Kalbacher, Daniel

doi:10.1016/j.jcin.2021.12.007

Cited by 32 publications

(21 citation statements)

References 25 publications

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“…• Further research is necessary to elucidate the complex interaction of mitral regurgitation, the mitral annulus, left atrial, and ventricular function and their response to TEER. outcomes in primary MR but not in secondary MR, 2,3 highlighting the difference in the driving force of TMPG in these two distinct populations. Finally, it remains uncertain whether elevated TMPG at baseline is associated with poor symptomatic response and long-term outcomes in patients undergoing TEER.…”

Section: Key Pointsmentioning

confidence: 92%

“…Early experience has demonstrated a 35% decrease in the mitral valve area after TEER, which has led to the exclusion of patients with a mitral valve area <4 cm 2 from pivotal trials investigating the use of TEER to avoid post‐procedural mitral stenosis 1 . Studies have focused on post‐procedural transmitral mean pressure gradient (TMPG) as a measure for assessing the development of new mitral stenosis, and have shown that an elevated post‐procedural TMPG is associated with increased mortality and heart failure rehospitalization after TEER 2,3 . However, post‐procedural TMPG may not be readily predictable, and it cannot aid in the intraprocedural decision‐making process for performing TEER.…”

mentioning

confidence: 99%

“…Furthermore, data regarding the etiology of MR (i.e., primary vs. secondary MR) were not provided in this study. This is important in assessing the role of TMPG, as it is now evident that postprocedural TMPG predicts worse clinical outcomes in primary MR but not in secondary MR, 2,3 highlighting the difference in the driving force of TMPG in these two distinct populations. Finally, it remains uncertain whether elevated TMPG at baseline is associated with poor symptomatic response and long‐term outcomes in patients undergoing TEER.…”

mentioning

confidence: 99%

“…for assessing the development of new mitral stenosis, and have shown that an elevated post-procedural TMPG is associated with increased mortality and heart failure rehospitalization after TEER. 2,3 However, post-procedural TMPG may not be readily predictable, and it cannot aid in the intraprocedural decision-making process for performing TEER. Therefore, the question arises as to whether preprocedural TMPG can be a reliable marker for predicting postprocedural hemodynamics and clinical outcomes.…”

mentioning

confidence: 99%

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Can patients be selected for transcatheter edge‐to‐edge repair based on the baseline transmitral gradient?

Ueyama

Block

2023

Cathet Cardio Intervent

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hemodynamics (HEMO), mitral valve disease (MVD), mitral valve disease percutaneous intervention (MVPI)Transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) involves the creation of a double-orifice that mimics the Alfieri stitch, but a concerning trade-off exists between the improvement of MR and the development of mitral stenosis. Early experience has demonstrated a 35% decrease in the mitral valve area after TEER, which has led to the exclusion of patients with a mitral valve area <4 cm 2 from pivotal trials investigating the use of TEER to avoid post-procedural mitral stenosis. 1 Studies have focused on postprocedural transmitral mean pressure gradient (TMPG) as a measure

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Section: Key Pointsmentioning

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Can patients be selected for transcatheter edge‐to‐edge repair based on the baseline transmitral gradient?

Ueyama

Block

2023

Cathet Cardio Intervent

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“…In an attempt to achieve a greater reduction in the MR, a higher transmitral valve gradient can be induced. Recently, reaching a mean transvalvular gradient pressure > 5 mmHg has been associated with adverse clinical and functional outcomes in patients with degenerative MR, but not in patients with functional MR [ 18 ]. Real-life information regarding mitral stenosis in this scenario is scarce because most studies only report the mean transmitral gradient but are missing other parameters about relevant mitral stenosis [ 6 ].…”

Section: Device-related Complicationsmentioning

confidence: 99%

Complications of the Percutaneous Mitral Valve Edge-To-Edge Repair: Role of Transesophageal Echocardiography

Flores

Mesa-Rubio

Ojeda

et al. 2022

JCM

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The use of transcatheter edge-to-edge repair for the treatment of mitral regurgitation has markedly increased in the last few years. The rate of adverse events related to the procedure is low; however, some of the complications that may occur are potentially dangerous. Due to the growing popularity of the technique, which is no longer limited to high-volume centers, knowledge of the complications related to the procedure is fundamental. Transesophageal echocardiography has a key role in the guidance of the intervention while allowing for the avoidance of most of these adverse events, as well as enabling us to diagnose them early. In this article, we review the main complications that might present during a transcatheter mitral edge-to-edge repair procedure (tamponade, thromboembolic events, single leaflet device attachment, device embolization, vascular injury…) while highlighting key aspects of transesophageal echocardiographic monitoring in the prevention and prompt diagnosis of these complications.

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The impact of baseline transmitral diastolic mean gradient on left atrial pressure reduction in patients undergoing transcatheter mitral valve edge‐to‐edge repair

Lugo-Fagundo

Pierre

Adedinsewo

et al. 2023

Cathet Cardio Intervent

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Background Elevated transmitral gradient post transcatheter mitral valve edge‐to‐edge repair (TEER) has been associated with worse outcomes. Whether an elevated baseline transmitral diastolic mean gradient (MG) ≥5 mmHg is associated with hemodynamic outcomes after TEER is unknown. Methods A total of 164 consecutive patients undergoing TEER at Mayo Clinic between June 2014 and May 2018 were analyzed in this retrospective study. Baseline demographics, as well as clinical, echocardiographic, and procedural data were obtained. Data on direct left atrial pressure (LAP) before and after TEER were recorded. Logistic regression models were constructed to evaluate the association between preprocedure transmitral diastolic mean gradient (pre‐MG) and (1) improvement in LAP following TEER, (2) postprocedure transmitral diastolic mean gradient (post‐MG). A decrease in LAP post TEER was considered an improvement in hemodynamic response. Pre‐MG was categorized as: ≥5 and <5 mmHg. Results Median age of the cohort was 81.5 years (Q1: 76.3, Q3: 87) and 34% were female. At baseline, median transmitral diastolic MG was 4 mmHg (Q1: 3, Q3: 5) and median LAP was 19 mmHg (Q1:16, Q3: 23.5). In a multivariable model, adjusted for age and sex, patients with pre‐MG ≥ 5 mmHg were less likely to see an improvement in LAP post TEER (adjusted odds ratio [aOR]: 0.22, 95% confidence interval [CI]: 0.09, 0.55; p = 0.001) and more likely to have elevated post‐MG (aOR; 7.08, 95% CI: 2.93, 17.13; p < 0.001). Conclusion Higher pre‐MG (≥5 mmHg) was associated with a lower reduction in LAP and higher residual transmitral gradient following TEER suggesting other potential contributors to increased LAP besides mitral regurgitation as a cause of elevated baseline MG.

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Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair

Cited by 32 publications

References 25 publications

Can patients be selected for transcatheter edge‐to‐edge repair based on the baseline transmitral gradient?

Can patients be selected for transcatheter edge‐to‐edge repair based on the baseline transmitral gradient?

Complications of the Percutaneous Mitral Valve Edge-To-Edge Repair: Role of Transesophageal Echocardiography

The impact of baseline transmitral diastolic mean gradient on left atrial pressure reduction in patients undergoing transcatheter mitral valve edge‐to‐edge repair

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