Assessing the Balance Between Less Mitral Regurgitation and More Residual Transmitral Pressure Gradient After MitraClip

Feldman, Ted; Guerrero, Mayra

doi:10.1016/j.jcin.2016.12.273

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…A potential limitation of the MitraClip device is the creation of MS, which can lead to poorer long‐term outcomes . However, well‐established guidelines and practices are currently in‐place to avoid such a result . For example, as per MitraClip IFU and EVEREST trials, MR patients with baseline MVA <4.0 cm 2 are contraindicated for MitraClip treatment .…”

Section: Discussionmentioning

confidence: 99%

Impact of simulated MitraClip on forward flow obstruction in the setting of mitral leaflet tethering: An in vitro investigation

Bloodworth

Pierce

Kohli

et al. 2018

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Impact of simulated MitraClip on forward flow obstruction in the setting of mitral leaflet tethering: An in vitro investigation

Bloodworth

Pierce

Kohli

et al. 2018

Cathet Cardio Intervent

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“…During TEER interventions, three of the basic hemodynamic surveillance parameters are the MVA, mean and maximum velocities, which are measured by ultrasound, and mean and maximum MPG, which are estimated by means of the simplified Bernoulli Equation (Equation 4). The MVA is an important indicator for assessing the suitability of a TEER procedure for a patient since guidelines recommend to only consider patients with a MVA>4 cm 2 for TEER ( 14 ). During and after the procedure, MVA and MPG are used to judge the risk of MS.…”

Section: Methodsmentioning

confidence: 99%

“…However, recurrence of MR and the risk of iatrogenic mitral stenosis (MS) are major issues and reduce the therapeutic effect ( 9 – 12 ). The opinions on residual and recurrent MR are rather concordant ( 13 , 14 ), whereas the risk of iatrogenic MS is discussed controversially. Early studies and case studies did not find evidence of an increased risk of post-op stenosis ( 5 , 6 , 15 ), while more recent studies witnessed cases of the high mitral gradient at diastolic filling after TEER in spite of seemingly normal pressure gradients during the intervention ( 9 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

“…Early studies and case studies did not find evidence of an increased risk of post-op stenosis ( 5 , 6 , 15 ), while more recent studies witnessed cases of the high mitral gradient at diastolic filling after TEER in spite of seemingly normal pressure gradients during the intervention ( 9 , 16 ). The challenge of balancing between residual regurgitation and increased mitral pressure gradient (MPG) after TEER is mentioned by several researchers ( 11 , 14 , 17 , 18 ). Singh et al ( 19 ) state an overall underestimated risk of iatrogenic MS and further call the best choice for measuring the MPG an “unanswered question.” An algorithm for estimating the required pre-interventional mitral valve area (MVA) to avoid an iatrogenic MS was developed by Kassar et al ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

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Effect of transcatheter edge-to-edge repair device position on diastolic hemodynamic parameters: An echocardiography-based simulation study

Vellguth

Barbieri

Reinthaler

et al. 2022

Front. Cardiovasc. Med.

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BackgroundTranscatheter edge-to-edge repair (TEER) has developed from innovative technology to an established treatment strategy of mitral regurgitation (MR). The risk of iatrogenic mitral stenosis after TEER is, however, a critical factor in the conflict of interest between maximal reduction of MR and minimal impairment of left ventricular filling. We aim to investigate systematically the impact of device position on the post treatment hemodynamic outcome by involving the patient-specific segmentation of the diseased mitral valve.Materials and methodsTransesophageal echocardiographic image data of ten patients with severe MR (age: 57 ± 8 years, 20% female) were segmented and virtually treated with TEER at three positions by using a position based dynamics approach. Pre- and post-interventional patient geometries were preprocessed for computational fluid dynamics (CFD) and simulated at peak-diastole with patient-specific blood flow boundary conditions. Simulations were performed with boundary conditions mimicking rest and stress. The simulation results were compared with clinical data acquired for a cohort of 21 symptomatic MR patients (age: 79 ± 6 years, 43% female) treated with TEER.ResultsVirtual TEER reduces the mitral valve area (MVA) from 7.5 ± 1.6 to 2.6 ± 0.6 cm2. Central device positioning resulted in a 14% smaller MVA than eccentric device positions. Furthermore, residual MVA is better predictable for central than for eccentric device positions (R2 = 0.81 vs. R2 = 0.49). The MVA reduction led to significantly higher maximal diastolic velocities (pre: 0.9 ± 0.2 m/s, post: 2.0 ± 0.5 m/s) and pressure gradients (pre: 1.5 ± 0.6 mmHg, post: 16.3 ± 9 mmHg) in spite of a mean flow rate reduction by 23% due to reduced MR after the treatment. On average, velocities were 12% and pressure gradients were 25% higher with devices in central compared to lateral or medial positions.ConclusionVirtual TEER treatment combined with CFD is a promising tool for predicting individual morphometric and hemodynamic outcomes. Such a tool can potentially be used to support clinical decision making, procedure planning, and risk estimation to prevent post-procedural iatrogenic mitral stenosis.

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“…The haemodynamic effects of MitraClip are complex. Repair of MR may decrease the post capillary pulmonary pressure but might create relative mitral stenosis 5 . Trans‐mitral increased gradient and the haemodynamic effects of the iatrogenic atrial septal defect (iASD) may affect post‐procedural sPAP, in relation with pre‐procedure values.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary artery pressures and outcomes after MitraClip

et al. 2020

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Aims We evaluated the impact of MitraClip on systolic pulmonary artery pressure (sPAP) and the effects of baseline sPAP on outcomes. Methods and results In a cohort of patients who underwent MitraClip implantation, three groups were defined according to pre-procedure sPAP levels. Clinical and echocardiographic data were compared. The study included 177 patients: 59 had severe pulmonary hypertension (PHT), 96 had mild to moderate PHT, and 22 had no PHT. In patients with pre-existing severe PHT, sPAP was reduced from 70.8 ± 9.2 to 56.8 ± 13.7 mmHg (P < 0.001), sPAP remained unchanged in patients with mild to moderate PHT but was significantly increased from 30.8 ± 4.3 to 38.6 ± 8.3 mmHg in the no-PHT group (P < 0.001). Improvement of sPAP was observed in 77% of severe PHT group, while worsening of sPAP was more common among patients with no-PHT [57% compared with 33% among the mild to moderate PHT and 7% in the severe PHT group, respectively, (P < 0.001)]. One year survival was similar among the study groups. Conclusions MitraClip decreases PHT among patients with severe PHT. A concerning finding is that most patients with no-PHT increase their sPAP.

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Assessing the Balance Between Less Mitral Regurgitation and More Residual Transmitral Pressure Gradient After MitraClip

Cited by 6 publications

References 7 publications

Impact of simulated MitraClip on forward flow obstruction in the setting of mitral leaflet tethering: An in vitro investigation

Impact of simulated MitraClip on forward flow obstruction in the setting of mitral leaflet tethering: An in vitro investigation

Effect of transcatheter edge-to-edge repair device position on diastolic hemodynamic parameters: An echocardiography-based simulation study

Pulmonary artery pressures and outcomes after MitraClip

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