Elevated Mitral Valve Pressure Gradient After MitraClip Implantation Deteriorates Long-Term Outcome in Patients With Severe Mitral Regurgitation and Severe Heart Failure

Neuß, Michael; Schau, Thomas; Isotani, Akihiro; Pilz, Markus; Schöpp, Maren; Butter, Christian

doi:10.1016/j.jcin.2016.12.280

Cited by 170 publications

(96 citation statements)

References 20 publications

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“…Unfortunately, in this case, AF with elevated HRs led to haemodynamic deterioration. A resting mean MVPG > 5 mmHg after PMVR has been associated with worse clinical outcome 8. However, MVPG may further increase during exercise or altered haemodynamics 9.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

et al. 2017

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A patient presented with symptoms of decompensated heart failure 2 months after percutaneous mitral valve (MV) repair. Echocardiography demonstrated impaired left ventricular function with elevated MV pressure gradients and pulmonary pressures during rapid atrial fibrillation. Heart rate control was achieved by implantation of a biventricular pacemaker with subsequent His‐bundle ablation because atrial fibrillation was refractory to medical treatment. During biventricular pacing at different rates (50–110 b.p.m.), heart rate correlated positively with both MV mean pressure gradient and global longitudinal strain and negatively with stroke volume. MV pressure gradients directly translated into elevated pulmonary pressures. Thus, rate control and biventricular pacing improved cardiac haemodynamics.

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Section: Discussionmentioning

confidence: 99%

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

et al. 2017

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“…The principle of MitraClip is based on Alfieri's edge‐to‐edge repair, where the anterior and the posterior leaflets are grasped and attached at the location of the regurgitation jet, thus creating a double orifice MV . Several clips can be implanted until the regurgitation is sufficiently reduced, but MV orifice area during diastole has to be monitored carefully during the procedure because elevated mitral gradients after TMVR are associated with adverse outcome . The edge‐to‐edge repair technique is a symptomatic therapy because the mechanism, either leaflet tethering or annulus dilatation, is not targeted.…”

Section: Transcatheter Mitral Valve Interventionsmentioning

confidence: 99%

“…[18][19][20] Several clips can be implanted until the regurgitation is sufficiently reduced, but MV orifice area during diastole has to be monitored carefully during the procedure because elevated mitral gradients after TMVR are associated with adverse outcome. 21,22 The edge-to-edge repair technique is a symptomatic therapy because the mechanism, either leaflet tethering or annulus dilatation, is not targeted.…”

Section: Mitraclipmentioning

confidence: 99%

Mitral valve interventions in heart failure

et al. 2018

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Secondary mitral regurgitation (MR) results from left ventricular dilatation and dysfunction. Quantification of secondary MR is challenging because of the underlying myocardial disease. Clinical and echocardiographic evaluation requires a multi‐parametric approach. Severe secondary MR occurs in up to one‐fourth of patients with heart failure with reduced ejection fraction, which is associated with a mortality rate of 40% to 50% in 3 years. Percutaneous edge‐to‐edge mitral valve repair (MitraClip) has emerged as an alternative to surgical valve repair to improve symptoms, functional capacity, heart failure hospitalizations, and cardiac haemodynamics. Further new transcatheter strategies addressing MR are evolving. The Carillion, Cardioband, and Mitralign devices were designed to reduce the annulus dilatation, which is a frequent and important determinant of secondary MR. Several transcatheter mitral valve replacement systems (Tendyne, CardiAQ‐Edwards, Neovasc, Tiara, Intrepid, Caisson, HighLife, MValve System, and NCSI NaviGate Mitral) are emerging because valve replacement might be more durable compared with valve repair. In small studies, these interventional therapies demonstrated feasibility and efficiency to reduce MR and to improve heart failure symptoms. However, neither transcatheter nor surgical mitral valve repair or replacement has been proven to impact on the prognosis of heart failure patients with severe MR, which remains high with a mortality rate of 14–20% at 1 year. To date, the primary indication for treatment of secondary severe MR is the amelioration of symptoms, reinforcing the value of a Heart Team discussion. Randomized studies to investigate the treatment effect and long‐term outcome for any transcatheter or surgical mitral valve intervention compared with optimized medical treatment are urgently needed and underway.

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“…MitraClip patients with post-procedural moderate MS (mean MVG 5 mmHg), where the overall rate of moderate MS among patients treated with MitraClip was found to be 25% [4,5]. In FMR patients in particular, MS severity after MitraClip may be further exacerbated by diastolic restriction of the anterior mitral leaflet (AML) caused by severe dilatation of the left ventricle (LV) and papillary muscle (PM) displacement [6].…”

Section: Deteriorated Long-term Outcomes Have Been Recently Demonstramentioning

confidence: 99%

“…In many cases, multiple MitraClip devices are used to treat MR , though placement of additional devices can further reduce mitral valve area (MVA) and increase of mean mitral valve gradient (MVG), leading to mitral stenosis (MS) . Deteriorated long‐term outcomes have been recently demonstrated in MitraClip patients with post‐procedural moderate MS (mean MVG ≥ 5 mmHg), where the overall rate of moderate MS among patients treated with MitraClip was found to be 25% . In FMR patients in particular, MS severity after MitraClip may be further exacerbated by diastolic restriction of the anterior mitral leaflet (AML) caused by severe dilatation of the left ventricle (LV) and papillary muscle (PM) displacement .…”

Section: Introductionmentioning

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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Elevated Mitral Valve Pressure Gradient After MitraClip Implantation Deteriorates Long-Term Outcome in Patients With Severe Mitral Regurgitation and Severe Heart Failure

Abstract: It is recommended that the quality of the implantation result be analyzed carefully and repositioning of the MC be considered in the case of an elevated pressure gradient over the mitral valve.

Cited by 170 publications

References 20 publications

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

Mitral valve interventions in heart failure

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

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