No abstract

Background The current data on the impact of the increased mitral gradient (MG) on outcomes are ambiguous, and intraprocedural assessment of MG can be challenging. Therefore, we aimed to evaluate (a) peri‐interventional dynamics of MG, (b) the impact of intraprocedural MG on clinical outcomes, and (c) predictors for unfavorable MG values after MitraClip. Methods We prospectively included patients who underwent MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after 6 months. 12‐month survival was documented. Results One hundred and seventy five patients (age 81.2 ± 8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups according to intraprocedural MG with a threshold of 4.5 mm Hg, determined by a multivariate analysis of predictors for 12‐month mortality (<4.5 mm Hg: Group 1, ≥4.5 mm Hg: Group 2). Intraprocedural MG ≥4.5 mm Hg was found to be the strongest independent predictor for 12‐month mortality (HR: 2.33, P = .03, OR: 1.70, P = .05), and >3.9 mm Hg was associated with adverse functional outcomes (OR: 1.96, P = .04). The baseline leaflet‐to‐annulus index >1.1 was found to be the strongest independent predictor (OR: 9.74, P = .001) for unfavorable intraprocedural MG, followed by the number of implanted clips (P = .01), MG at baseline (P = .02), and central clip implantation (P = .05). Conclusion An intraprocedural MG <3.9 mm Hg appears to be the best strategy for 1‐year survival and favorable functional outcomes after edge‐to‐edge MV repair with MitraClip independently from MR etiology. Peri‐interventional echocardiographic and procedural parameters are useful for the adequate assessment of intraprocedural MG.

Das Remanufacturing, bisher geprägt durch manuelle und kostenintensive Prozesse, ist ein entscheidender Schritt auf dem Weg zu einer ressourcenschonenden Kreislaufwirtschaft. Industrie und Forschung sind sich einig, dass der Einzug von Industrie 4.0 Technologien den Schlüssel zu einer Entwicklung automatisierter und wirtschaftlicher Remanufacturing-Systeme darstellt. Basierend auf einer systematischen Literaturrecherche widmet sich dieser Beitrag der Analyse vielversprechender Industrie 4.0-Ansätze mit dem Fokus auf den übergeordneten Gesamtprozess sowie den Teilprozessen der Demontage und der Inspektion. Die Ergebnisse legen nahe, dass es an zusätzlichem Wissen, Erfahrung und Forschung bei der Entwicklung und realen Demonstration der Ansätze und deren Übertragbarkeit auf breitere Anwendungsfelder bedarf.

Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.