Comparison of left atrial pressure monitoring with dedicated catheter versus steerable guiding catheter during transcatheter mitral valve repair

Eleid, Mackram F.; Reeder, Guy S.; Rihal, Charanjit S.

doi:10.1002/ccd.27430

Cited by 10 publications

(12 citation statements)

References 7 publications

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“…However, the creation of unequal orifices, eccentric regurgitation, and multiple residual jets may limit accurate measurements due to underlying hemodynamic assumptions by TEE. Invasive hemodynamic monitoring technique has been described to evaluate physiologic changes after MitraClip repair . Mean LAP depends on left atrial compliance and may remain normal until advanced stages of MR. V‐wave morphology has also been used to estimate MR severity.…”

Section: Discussionmentioning

confidence: 99%

“…The MitraClip NT CDS has made several modifications as described by Gajjar and colleagues that has made continuous real‐time LAP monitoring feasible via the SGC side port . However, Eleid and colleagues compared LAP measurements using a pigtail catheter with the SGC side port and reported a significant overdamping of V‐wave among SGC waveforms . Using the SGC to monitor LAP continuously does depend on several factors, including extent of SGC and CDS manipulations during the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…With the new NT system, with the stopcock attached to a fluid‐filled transducer system leveled to the patient to the phlebostatic axis and appropriately calibrated, LAP waveforms could be obtained even with the CDS inserted (Figure ). In situations where overdamping of the wave form was observed after CDS insertion, LAP/V‐wave changes were semi quantitatively compared.…”

Section: Methodsmentioning

confidence: 99%

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Continuous invasive hemodynamic monitoring using steerable guide catheter to optimize mitraclip transcatheter mitral valve repair: A multicenter, proof‐of‐concept study

Ong

Kaple

Ramlawi

et al. 2018

J Interven Cardiology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Continuous invasive hemodynamic monitoring using steerable guide catheter to optimize mitraclip transcatheter mitral valve repair: A multicenter, proof‐of‐concept study

Ong

Kaple

Ramlawi

et al. 2018

J Interven Cardiology

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“…Options for adjunctive hemodynamic quantitative data consist of change in end‐tidal CO 2 and/or direct left atrial (LA) pressure measurement using a catheter separate from the MitraClip guide catheter . Intraprocedural direct LA pressure measurement has been associated with greater MR reduction and improved 6‐minute walk test (6MWT) .…”

Section: Introduction/backgroundmentioning

confidence: 99%

“…Intraprocedural direct LA pressure measurement has been associated with greater MR reduction and improved 6‐minute walk test (6MWT) . Continuous direct LA pressure measurement can be obtained by utilizing a separate catheter (e.g., pigtail catheter) as previously described or utilizing a pressure port via the MitraClip steerable guide catheter (SGC) . However, continuous LA pressure measurement via a separate catheter can be limited by insecure intraprocedural venous hemostasis and measurement via the MitraClip SGC is limited by pressure dampening.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Intraprocedural direct left atrial and wedge pressure correlation during transcatheter mitral valve repair: Results from a single center registry

Chen

Mantri

Eng

et al. 2018

Cathet Cardio Intervent

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Objectives This study investigates the correlation of occlusive wedge pressure (WP) with direct left atrial (LA) pressure in patients with severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVr) with MitraClip. Background There is interest in acquiring objective hemodynamic parameters for intraprocedural guidance in patients undergoing MitraClip. Methods The study included 94 patients with severe MR at prohibitive surgical risk who underwent MitraClip at the University of California Davis Medical Center between 2014 and 2016. Results An average of 1.8 ± 0.7 clips were used to achieve MR grade of 2+ or less in 99% of patients. Correlation analysis of all (n = 236) pre‐clip, inter‐clip, and final‐clip WP and LA pressures yielded a Pearson's R (r) of 0.85 and 0.79 for mean WP vs mean LA and WP V vs LA V, respectively. Median LA V to mean LA ratio (LAV:mLA) was 1.75 (IQR 1.5–1.9). 79% (n = 74) of patients had LAV:mLA ratio ≥ 1.5 with associated WP V vs LA V correlation (r) of 0.83. In patients with LAV:mLA ratio < 1.5, the correlation (r) was 0.69. Baseline characteristics were not significantly different between patients with LAV:mLA ratio ≥ 1.5 and patients with LAV:mLA ratio < 1.5. Post‐procedure, median LA V: mean LA ratio decreased from 1.75 to 1.4, P = 0.0001. Conclusions Correlation between WP and direct LA pressure in patients with severe MR undergoing Mitraclip is modest. Caution is advised when using WP to approximate LA pressure intraprocedurally, especially in patients with baseline low LAV:mLA ratios.

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30‐day patient reported outcomes can be predicted by change in left atrial pressure and not change in transmitral gradient following MitraClip

Pierre

Adedinsewo

Al‐Hijji

et al. 2021

Cathet Cardio Intervent

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Background Change in left atrial pressure (LAP) has been shown to be associated with symptom improvement post‐MitraClip; however, the association between acute procedural changes in transmitral diastolic mean gradient (MG) compared to LAP and symptom improvement is not well established. Methods 164 consecutive patients undergoing MitraClip at Mayo Clinic between June 2014 and May 2018 were included. Preclip and postclip MG and LAP were recorded. Baseline demographics, clinical, and echocardiographic outcomes, including 30‐day New York Heart Association (NYHA) functional status were obtained from patient charts. Results Median age was 81.5 years (IQR: 76.3, 87), 34% were female and 94.5% had NYHA class III and IV functional status at baseline. At baseline, median MG was 4 mmHg (IQR: 3, 5) and LAP was 19 mmHg (IQR: 16, 23.5). Following MitraClip deployment, the median MG was 4 mmHg (IQR: 3, 6) and the median LAP was 17 mmHg (IQR: 14, 21), 69.5% of patients had less than moderate MR. There was no statistically significant association between change in MG and NYHA functional class at 30 days (OR = 0.95, 95% CI: 0.76–1.20). However, a reduction in LAP following MitraClip deployment was significantly associated with improvement in NYHA functional status at 30 days following adjustments for age and sex (aOR 3.36, 95% CI: 1.34–8.65). There was no significant correlation between change in mean LAP and change in MG (p = .98). Conclusion Unlike change in left atrial pressure, change in MG post‐MitraClip was not associated with patient reported outcomes at 30 days and did not correlate with change in left atrial pressure. Long‐term follow up is needed to evaluate the impact of LA pressure on symptoms.

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Comparison of left atrial pressure monitoring with dedicated catheter versus steerable guiding catheter during transcatheter mitral valve repair

Cited by 10 publications

References 7 publications

Continuous invasive hemodynamic monitoring using steerable guide catheter to optimize mitraclip transcatheter mitral valve repair: A multicenter, proof‐of‐concept study

Continuous invasive hemodynamic monitoring using steerable guide catheter to optimize mitraclip transcatheter mitral valve repair: A multicenter, proof‐of‐concept study

Intraprocedural direct left atrial and wedge pressure correlation during transcatheter mitral valve repair: Results from a single center registry

30‐day patient reported outcomes can be predicted by change in left atrial pressure and not change in transmitral gradient following MitraClip

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