Postprocedural Changes of Tricuspid Regurgitation After MitraClip Therapy for Mitral Regurgitation

Toyama, Kentaro; Ayabe, Kengo; Kar, Saibal; Kubo, Shunsuke; Minamishima, Toshinori; Rader, Florian; Shiota, Takahiro; Nishioka, Toshihiko; Siegel, Robert J.

doi:10.1016/j.amjcard.2017.05.044

Cited by 36 publications

(24 citation statements)

References 20 publications

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“…Moreover, non‐invasive analysis of PAP in 102 patients before and 1 year after MitraClip using transthoracic Doppler echocardiography also documented a significant decrease in systolic PAP, derived from tricuspid regurgitation 21. This is in line with our results, where we could not only find a significant reduction in systolic PAP over time but also a substantial and significant, almost 64% decrease in diastolic PAP.…”

Section: Discussionsupporting

confidence: 91%

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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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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Section: Discussionsupporting

confidence: 91%

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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“…Confirming earlier published data, we found that TMVR is capable of influencing severity of concomitant TR. A reduction could be observed in 35% of our patients’ cohort, which is comparable to findings from other registries [ 10 , 11 ]. Regarding the prognostic impact of peri-interventional development of TR severity, retrospective studies on patients undergoing transcatheter mitral valve edge-to-edge repair reported that also post-interventional severity of TR could account for impaired long-term prognosis [ 11 , 30 ].…”

Section: Discussionsupporting

confidence: 91%

“…Contemporarily, only a minority of TR patients are treated up to now [ 9 ]. There is evidence, that TMVR is capable of reducing severity of concomitant TR in approximately a fourth to a third of the MR patients [ 10 , 11 ]. With the development of treatment devices dedicated to interventional tricuspid valve repair for patients at elevated surgical risk, the question of a prognostic impact of TR in patients with significant MR gains further relevance.…”

Section: Introductionmentioning

confidence: 99%

Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair

et al. 2021

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Background Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited. Methods Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed. Results Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12–2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00–2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15–9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021). Conclusion In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit. Graphic abstract

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“…did not change. Another recent study with individual patient data reported an improvement of severe TR after edge‐to‐edge mitral valve repair in only 18% of patients . Thus, a ‘wait and see’ approach, assuming a spontaneous reduction of severe TR in all patients, might not be worthwhile considering the worse prognosis associated with severe TR.…”

Section: Discussionmentioning

confidence: 99%

Six‐month outcome after transcatheter edge‐to‐edge repair of severe tricuspid regurgitation in patients with heart failure

Orban

Besler

Braun

et al. 2018

European J of Heart Fail

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Postprocedural Changes of Tricuspid Regurgitation After MitraClip Therapy for Mitral Regurgitation

Cited by 36 publications

References 20 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

Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair

Six‐month outcome after transcatheter edge‐to‐edge repair of severe tricuspid regurgitation in patients with heart failure

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