The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation

Abstract

Background The effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation (MR) have not been well characterized. We evaluated acute changes in mitral annular shape and dimensions, and their effect on MR severity, in patients with functional and degenerative MR following MitraClip®. Methods Patients that underwent MitraClip® between January 2013 and May 2016 at our institution were retrospectively reviewed. Exclusions: inadequate images, prior mitral valve repair, and rapid atrial fibrillation. Intra‐procedure TEE 3D images acquired prior to and after implantation of MitraClip® were analyzed using software to model the mitral valve apparatus. Results Of seventy‐eight patients that underwent MitraClip® procedure, 60 were eligible. Mean age was 78.3 ± 11 years. Severe MR (4+) was present in 37 patients, moderately/severe MR (3+) in 23. All patients achieved MR reduction to ≤2. 3D annular circumference, bicommissural diameter, and anteroposterior diameter had a significant size reduction after MitraClip®. None of the mitral annular measures had significantly different mean change between the large and small MR change groups at the 0.05 significance level. Conclusions In patients with functional or degenerative MR, the MitraClip® significantly affect mitral annular dimensions; however, these changes do not correlate with the immediate MR reduction.

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

“…Thus far, several 3D TEE studies have suggested geometrical effect with regard to MV annulus diameter during MitraClip implantation in patients with FMR. These studies discovered reduction in AP diameter in FMR 4,5,18 and demonstrated its association with MR improvement 3,4 …”

“…The AP diameter reduction by MitraClip in degenerative MR remained controversial 3,5,18,19 . A more recent study by Patzelt et al indicated reduction in MV annulus AP diameters in a larger cohort of 77 patients with DMR and showed its correlation with residual MR.…”

“…The MitraClip system replicates the surgical edge‐to‐edge suture of both MV leaflets and creates a double orifice 2 . Deployment of MitraClip system alters MV geometry 3‐5 . Effects of transcatheter edge‐to‐edge repair may differ according to the etiology of mitral regurgitation (MR) and mitral valve geometry.…”

“…Effects of transcatheter edge‐to‐edge repair may differ according to the etiology of mitral regurgitation (MR) and mitral valve geometry. Recent studies have compared the geometrical effect of MitraClip therapy in patients with functional MR (FMR) and degenerative MR (DMR) using an intraprocedural three‐dimensional (3D) transoesophageal echocardiography (TEE) 3,5,6 . However, few data are available about the specific impact of percutaneous edge‐to‐edge repair in patients with DMR.…”

Future Perspectives in Percutaneous Treatment of Tricuspid Regurgitation

“…Similar to annuloplasty devices, future studies are required to identify which patients and specifically anatomies are most suited to treatment with leaflet plasty devices. In particular, leaflet devices could be useful in patients with combined annular dilatation and leaflet remodeling (leaflet tethering) because of their capacity to reshape the TV and indirectly reduce annular dimensions ( 14 , 23 ). However, the following points need to be addressed in the future: ◾ Residual regurgitation and how to achieve good procedural results .…”