Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT_R by three‐dimensional echocardiography

Abstract

Background: Mitral valve (MV) repair with MitraClip system is a safe treatment option for high-risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three-dimensional echocardiography (3D-E), changes occurring in MV after implantation of third generation MitraClip XT R device, with specific reference to the underlying MR mechanism (functional vs degenerative, FMR vs DMR). Methods:We prospectively enrolled 59 patients, who underwent intra-procedural 3D-E before and after device deployment. Three-D datasets were analyzed off-line, using a dedicated semiautomatic software, to obtain parametric quantification of mitral anatomy.Results: Post-procedural MR of mild or lesser degree was achieved in 40 patients (68%), with no differences between FMR and DMR (p 0.9). After MitraClip XT R implantation, the FMR group experienced an immediate annular resizing, with reduction of antero-posterior diameter (p 0.024) and sphericity index (p 0.017), next to a recovery of physiological saddle-shape, defined by lower non-planar angle (p ≤0.001) and higher annulus height to commissural width ratio (p ≤0.001). On the opposite, the DMR group revealed a significant decrease of maximum annular velocity (p 0.027), addressing a mechanic effect of the device deployment. Finally, baseline anterior mitral leaflet angle was found as an independent predictor of acute procedural result (OR 6.7,], p 0.049). Conclusions:MitraClip XT R implantation acts in restoring the original mitral geometry, with distinctive effects according to MR mechanism. Three-D parametric quantification of MV sheds new light on changes occurring in the valvular apparatus, and helps identifying possible new predictors of acute procedural success.

Short‐Term Effects of Different Transcatheter Edge‐to‐Edge Devices on Mitral Valve Geometry

“…Previous studies evaluating short‐term effects of the MitraClip system on MV geometry demonstrated a significant reduction of the AP diameter and annular dimensions. 3 , 5 Our findings confirm these described effects in a saddle‐shaped 4D MV model. Notably, despite the more flexible scaffold, the PASCAL‐treated cohort demonstrated a comparable reduction of the AP diameter, annular circumference, and area of the MV.…”

“… 3 Previous studies demonstrated that TEER using the MitraClip system (Abbott Vascular, Santa Clara, CA) significantly reduced annular dimensions throughout the cardiac cycle in both primary mitral regurgitation (PMR) and SMR, as quantified by 3‐dimensional (3D) echocardiography. 4 , 5 …”

Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future

“…TEER can reduce the intensity of the symptoms of SMR and its prevalence because of the acute changes in mitral valve geometry as follows; improved coaptation area and mitral valve tethering, decreased anteroposterior diameter and area of the mitral annulus, and increased sphericity of the mitral annulus ( 45 – 50 ), all of which lead to a persistent reduction of the SMR and improvement of the functional status ( 45 , 46 ). Such acute changes following TEER seem to resist dynamic SMR derived from changes in the mitral valve geometry during exercise.…”