Mitral valve hemodynamic effects of percutaneous edge‐to‐edge repair with the MitraClip™ device for mitral regurgitation

AimPatients with advanced systolic chronic heart failure frequently suffer from progressive functional mitral regurgitation. We report our initial experience in patients with an implanted pulmonary artery pressure (PAP) sensor, who developed severe mitral regurgitation, which was treated with the MitraClip system. We non‐invasively compared changes in PAP values in patients after MitraClip with PAP changes in patients without MitraClip.Methods and resultsAmong 28 patients with New York Heart Association III heart failure with implanted PAP sensor for haemodynamic telemonitoring from a single centre, four patients (age 66 ± 6 years, left ventricular ejection fraction 21 ± 3%, and cardiac index 1.8 ± 0.3) received a MitraClip procedure and were compared with 24 patients (age 72 ± 8 years, left ventricular ejection fraction 26 ± 9.9%, and cardiac index 2.0 ± 1.0) without MitraClip procedure in a descriptive manner. Ambulatory PAP values were followed for 90 days in both groups. In comparison with the PAP values 4 weeks before MitraClip procedure, PAP was profoundly reduced in all four patients after 30 days (ΔPAPmean −11 ± 5, ΔPAPdiast −7 ± 3 mmHg, P < 0.02) as well as after 90 days (ΔPAPmean −6.3 ± 6, ΔPAPdiast −1 ± 3 mmHg). Reductions in PAP were accompanied by a profound reduction in N terminal pro brain natriuretic peptide as well as clinical and echocardiographic improvement. When analysing the dynamics with a regression model, reductions in all PAP values were significantly greater after MitraClip compared with conservative haemodynamic monitoring (P < 0.001).ConclusionsThe efficacy of the interventional MitraClip procedure on clinical symptoms can be confirmed by haemodynamic telemonitoring. Thus, daily non‐invasive haemodynamic telemonitoring allows, for the first time, for a continuous assessment of the haemodynamic efficacy of novel therapies in patients with chronic heart failure.

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“…The very early study by Herrmann et al 16. focused on changes in transmitral gradients due to double orifice construction.…”

Section: Discussionmentioning

confidence: 99%

Daily non‐invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure

et al. 2018

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“…[1][2][3][4][5][6][7][8] Heart failure (HF) is complicated in most candidates for MC. N-terminal pro-Btype natriuretic peptide (NT-pro BNP) is an established biomarker of HF.…”

mentioning

confidence: 99%

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

et al. 2017

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SummaryMitraClip (MC) is an alternative therapeutic option for patients with severe mitral regurgitation (MR) who are at high surgical risk. Most candidates for MC have severe heart failure (HF) with increased N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels. We sought to clarify the response of NT-pro BNP after MC and to identify the determinants of NT-pro BNP nonresponders. Among 136 consecutive patients successfully treated with MC, we excluded 20 patients due to low baseline NT-pro BNP levels and therefore examined 116 patients. NT-pro BNP responders were defined as patients whose NT-pro BNP levels decreased by > 30% at 6 months after MC. Mean NT-pro BNP levels significantly decreased from 6,117 pg/mL at baseline to 4,143 pg/mL at 6 months after MC (P < 0.001); 61 patients (53%) were responders. Diabetes mellitus (DM) (51% versus 25%; P = 0.003) and atrial fibrillation (67% versus 49%; P = 0.049) were more common in nonresponders. Baseline New York Heart Association (NYHA) class and NT-proBNP levels were higher in responders. Right ventricular systolic dysfunction (RVSD) defined as tricuspid annular plane systolic excursion (TAPSE) < 15 mm was more common in nonresponders (41% versus 18%; P = 0.008). Multivariable logistic regression analysis revealed that DM (odds ratio [OR], 2.966; P = 0.014), RVSD (OR, 3.948; P = 0.006), and baseline NT-proBNP > 5,000 pg/mL (OR, 0.204; P = 0.001) were independent determinants of nonresponders. All-cause death tended to be less common in responders to NT-pro BNP (20% versus 31%; P = 0.163). In conclusion, NT-pro BNP levels significantly decreased after MC. DM and RVSD were determinants of NT-pro BNP nonresponse after the MC procedure. (Int Heart J 2017; 58: 225-231)

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“…[11][12][13] Some of these devices are now under clinical investigation. [103][104][105] Considering the 1-year failure of conventional annuloplasty when sewn directly on the annulus with a variety of ring types and the complexity of the ischemic MR jet, achieving late success with this approach will be challenging and assumes that the patient has coronary anatomy that will allow the operator to place the device.…”

Section: Coronary Sinus and Annular Approachesmentioning

confidence: 99%

“…A feasibility trial was completed in the United States, and a phase 2 randomized trial is ongoing. [11][12][13][14] This may be a practical approach for patients with a simple localized prolapsed segment; however, surgical experience with the edgeto-edge technique indicates significant recurrent MR if the procedure is not accompanied by an annuloplasty, resulting in a need for reoperation in 30% of patients at 5 years (versus 8% in those with an annuloplasty; Pϭ0.02). 79,83 The longterm results of the percutaneous edge-to-edge devices have yet to be reported, and greater clinical experience is needed to determine whether the possibility for later valve repair will be reduced because of trauma to the valve leaflets during attempted clip application or scarring of the leaflets after years of clip attachment.…”

Section: Edge-to-edge Approachesmentioning

confidence: 99%

Evolving Concepts and Technologies in Mitral Valve Repair

Fedak

McCarthy

Bonow³

2008

Circulation

154

109

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Mitral valve hemodynamic effects of percutaneous edge‐to‐edge repair with the MitraClip™ device for mitral regurgitation

Abstract: Echocardiographic and hemodynamic measurements after percutaneous mitral valve repair with the MitraClip show an expected decrease in mitral valve area with no evidence of clinically significant mitral stenosis either immediately after clip deployment or after 12 months of follow-up.

Cited by 80 publications

References 12 publications

Daily non‐invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure

Daily non‐invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

Evolving Concepts and Technologies in Mitral Valve Repair

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