Author + information
- Frank Corrigan,
- Aneel Maini,
- Ankit Parikh,
- Ioannis Parastatidis,
- Patricia Keegan,
- Sharon Howell,
- Vinod Thourani,
- Stephen Clements,
- Vasilis Babaliaros and
- Stamatios Lerakis
Background: The effects of hemodynamic changes during percutaneous mitral valve repair (PMVR) with MitraClip (Abbott Vascular) are incompletely characterized. We compared periprocedural invasive and echocardiographic hemodynamic changes with 30-day follow-up echocardiograms. We hypothesized that periprocedural normalization of pulmonary venous (PV) flow is predictive of ventricular remodeling.
Methods: We retrospectively reviewed records and periprocedural transesophageal echocardiograms of 58 consecutive patients (age 75±12 years) from 5/2013-8/2015 who underwent PMVR for severe mitral regurgitation at our institution. Two patients were excluded as a clip was not placed. We assessed periprocedural PV waveforms (S and D waves) by velocity and volume-time integral (VTI) measured before and after PMVR. Change in left atrial pressure (LAP) and V-wave before and after PMVR were recorded. 47 patients had transthoracic echocardiograms at follow-up (median 34 days) where we compared the first difference of pre- and post-PMVR parameters.
Results: At the beginning of the procedure, 70% had systolic flow reversal and 30% systolic blunting. After PMVR, 7% had systolic reversal, 69% systolic blunting, and 24% normalized PV flow (p <.001). The mean LAP and V-wave reduced by 6 and 21 mmHg (both p <.001). At follow-up, the mean mitral gradient increased from 3 to 5 mmHg (p <.001). Mean left ventricular ejection fraction (LVEF) declined though left ventricular diastolic diameter improved (43% vs 38%, p= .005; 5.7 vs. 5.4 cm, p= .001). The post-S/D velocity ratio, post-S wave VTI, and periprocedural change in S/D ratio and were positively associated with change in LVEF (r= .36, p= .027; r= .36, p= .029; r= .37, p= .026). Change in LVEF at follow-up was significantly higher in those with normalized PV flow (+3% vs −8%, p= .014). Reduction in LAP and V-wave were not associated.
Conclusions: Pulmonary venous flow waveforms are important hemodynamic markers of procedural success during percutaneous mitral valve repair. Periprocedural normalization of the pulmonary venous flow may predict left ventricular remodeling. A larger cohort with longer follow-up will be important for further assessment.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Structural Heart Interventions: Focus on Mitral Valve, Left Atrial Appendage and HOCM
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 1156-176
- 2017 American College of Cardiology Foundation