Changes in mitral valve geometry after percutaneous valve repair with the MitraClip® System

Traşcă, Livia; Sanchís, Laura; Regueiro, Ander; Freixa, Xavier; Vinereanu, Dragoş; Sitges, Marta

doi:10.1007/s10554-020-02137-4

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Comparably, in their review of 38 patients with successful TEER, Trasca et al [28] also reported acute reduction in anterior-posterior diameter following TEER (38.6 ± 7 vs. 31.1 ± 6 mm, P < 0.001) that persisted at 8.1 ± 4 months follow-up (32.9 ± 5 mm at follow-up). The authors also observed a significant correlation between the decrease in anterior-posterior diameter and reduction in severity of mitral regurgitation ( r = 0.414; P = 0.01) [28].…”

Section: Effect Of Transcatheter Edge-to-edge Repair On Mitral Annula...mentioning

confidence: 85%

“…Importantly, they also reported an inverse, albeit weak, correlation between the degree of residual mitral regurgitation and the reduction in anterior-posterior diameter (r ¼ À0.15, P ¼ 0.04) [27]. Comparably, in their review of 38 patients with successful TEER, Trasca et al [28] also reported acute reduction in anterior-posterior diameter following TEER (38.6 AE 7 vs. 31.1 AE 6 mm, P < 0.001) that persisted at 8.1 AE 4 months follow-up (32.9 AE 5 mm at followup). The authors also observed a significant correlation between the decrease in anterior-posterior diameter and reduction in severity of mitral regurgitation (r ¼ 0.414; P ¼ 0.01) [28].…”

Section: Intermediatementioning

confidence: 99%

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The impact of transcatheter edge-to-edge repair on mitral valve annular geometry

Eqbal

Gupta

Fam

et al. 2022

Current Opinion in Cardiology

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Purpose of reviewMitral valve transcatheter edge-to-edge repair (TEER) is becoming increasingly common to treat severe mitral regurgitation. However, the lack of concomitant annuloplasty raises concerns regarding its durability. As a result, there is an emerging body of literature evaluating the impacts of TEER on mitral annular geometry. In this review, we summarize the most recent literature evaluating the impacts of TEER on annular geometry in the acute, intermediate and long-term. We also review the relationship between changes in annular geometry and clinical endpoints. Recent findingsCurrent evidence suggests that TEER acutely induces favourable changes in mitral annular size and shape, which may persist for at least up to 1 year. Few studies suggest that TEER-induced annular remodelling is associated with positive clinical outcomes.

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Section: Effect Of Transcatheter Edge-to-edge Repair On Mitral Annula...mentioning

confidence: 85%

Section: Intermediatementioning

confidence: 99%

The impact of transcatheter edge-to-edge repair on mitral valve annular geometry

Eqbal

Gupta

Fam

et al. 2022

Current Opinion in Cardiology

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“…Several studies also using 3D TEE echocardiography were able to show A-Pd reduction during M-TEER (8-12, 14, 15, 20). However, some of these studies did not distinguish between FMR and DMR patients, but provided cumulative results for both entities (9,13). Other authors selectively included FMR patients (20) or observed A-Pd reduction only among FMR patients in their analyses (8,11,12).…”

Section: Discussionmentioning

confidence: 99%

“…Few studies reported significant A-Pd reduction in both etiologies (10) with more pronounced A-Pd reduction among FMR patients (15). In terms of additional annular parameters, many investigators similarly reported a decrease in AA (2D or 3D) aside from A-Pd reduction (8,9,11,13,20), while others did not detect a reduction in AC or AA (14,20). Based on the number of studies, stronger evidence is found for reduction of AA and AC in FMR (8,11,15) compared to DMR (15).…”

Section: Discussionmentioning

confidence: 99%

Transcatheter edge-to-edge-repair of functional mitral regurgitation induces significant remodeling of mitral annular geometry

Paukovitsch¹,

Felbel²,

Jandek³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundMitral annular alterations in the context of heart failure often lead to severe functional mitral regurgitation (FMR), which should be treated with transcatheter edge-to-edge repair (M-TEER) according to current guidelines. M-TEER's effects on mitral valve (MV) annular remodeling have not been well elucidated.Methods141 consecutive patients undergoing M-TEER for treatment of FMR were included in this investigation. Comprehensive intraprocedural transesophageal echocardiography was used to assess the acute effects of M-TEER on annular geometry.ResultsAverage patient age was 76.2 ± 9.6 years and 46.1% were female patients. LV ejection fraction was reduced (37.0% ± 13.7%) and all patients had mitral regurgitation (MR) grade ≥III. M-TEER achieved optimal MR reduction (MR ≤ I) in 78.6% of patients. Mitral annular anterior-posterior diameters (A-Pd) were reduced by −6.2% ± 9.5% on average, whereas anterolateral-posteromedial diameters increased (3.7% ± 8.9%). Overall, a reduction in MV annular areas was observed (2D: −1.8% ± 13.1%; 3D: −2.7% ± 13.7%), which strongly correlated with A-Pd reduction (2D: r = 0.6, p < 0.01; 3D: r = 0.65, p < 0.01). Patients that achieved A-Pd reduction above the median (≥6.3%) showed significantly lower rates of the composite endpoint rehospitalization for heart failure or all-cause mortality than those with less A-Pd reduction (9.9% vs. 28.6%, p = 0.037, log-rank p = 0.039). Furthermore, patients reaching the composite endpoint had an increase in annular area (2D: 3.0% ± 15.4%; 3D: 1.9% ± 15.3%), whereas those not reaching the endpoint showed a decrease (2D: −2.7% ± 12.4%; 3D: −3.6% ± 13.3%), although residual MR after M-TEER was similar between these groups (p = 0.57). In multivariate Cox regression adjusted for baseline MR, A-Pd reduction ≥6.3% remained a significant predictor of the combined endpoint (OR: 0.35, 95% CI: 0.14–0.85, p = 0.02).ConclusionOur findings indicate that effects of M-TEER in FMR are not limited to MR reduction, but also have significant impact on annular geometry. Moreover, A-Pd reduction, which mediates annular remodeling, has a significant impact on clinical outcome independent of residual MR.

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“…Hirasawa et al used an automated system to calculate the leaflet length and annulus size, while we measured these parameters on two-dimensional images after determining the exact positions of the mitral annulus and the midpoints of the AML and PML using 3D software, as previously reported. 14 The change in MV annulus shape after TMVR was described in earlier studies, and the degree of reduction in AP diameter correlated with the reduction of MR. 13,32 However, the ability of the AP annulus diameter at baseline to predict the degree of residual MR varies between reports. 10,13,31 Although the sphericity index predicted residual MR in the univariable analysis in this study, it was not significant in multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve leaflet stiffness predicts residual mitral regurgitation after transcatheter edge‐to‐edge mitral valve repair

Hashimoto,

Yamano,

Yamano

et al. 2023

Echocardiography

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BackgroundResidual regurgitation after transcatheter edge‐to‐edge mitral valve repair (TMVR) is a predictor of poor prognosis in patients with functional mitral regurgitation (FMR). This study sought to identify the mitral valve (MV) parameters measured by three‐dimensional transesophageal echocardiography (3D‐TEE) and MV leaflet features that predict residual mitral regurgitation (MR) after TMVR in patients with FMR.MethodsConsecutive patients with FMR who underwent TMVR were classified into two groups based on the degree of residual MR just after TMVR: < 2+ in the optimal MR reduction group and ≥ 2+ in the suboptimal MR reduction group. The two groups were compared with respect to 3D‐TEE parameters and the MV leaflet features, including the following parameters: stiffness, defined as a leaflet that remains at a fixed angle even during diastole, and thickness, measured in both clear and rough zones.ResultsThirty‐four of 46 patients (74%) were classified as the optimal MR reduction group. Multivariable analysis showed that anterior mitral leaflet + posterior mitral leaflet length/anteroposterior annulus diameter (p = .044) and MV leaflet stiffness (p = .007) were independent predictors of residual MR.ConclusionMV leaflet stiffness and the ratio of MV leaflet lengths to the annulus diameter may be good predictors of residual MR after TMVR in patients with FMR.

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Changes in mitral valve geometry after percutaneous valve repair with the MitraClip® System

Cited by 5 publications

References 22 publications

The impact of transcatheter edge-to-edge repair on mitral valve annular geometry

The impact of transcatheter edge-to-edge repair on mitral valve annular geometry

Transcatheter edge-to-edge-repair of functional mitral regurgitation induces significant remodeling of mitral annular geometry

Mitral valve leaflet stiffness predicts residual mitral regurgitation after transcatheter edge‐to‐edge mitral valve repair

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