Insufficient Mitral Leaflet Remodeling in Relation to Annular Dilation and Risk of Residual Mitral Regurgitation After MitraClip Implantation

Hirasawa, Kensuke; Namazi, Farnaz; Pio, Stephan Milhorini; Vo, Ngoc Mai; Marsan, Nina Ajmone; Bax, Jeroen J.; Delgado, Victoria

doi:10.1016/j.jcmg.2020.08.019

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…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. The sphericity index and the annulus diameter are parameters related only to the MV annulus.…”

Section: Discussioncontrasting

confidence: 66%

“…27,30 In addition to parameters reflecting chamber remodeling, MV features have been reported to predict the degree of residual MR. AML + PML length / AP annulus diameter was reported as an independent predictor of residual MR in patients with FMR. 8,30 Although the calculation methods differed between reports, insufficient remodeling of the MV leaflet in relation to the MV annulus diameter is considered one cause of excessive residual MR. Hirasawa et al 31 analyzed 3D TEE data in patients with FMR who underwent TMVR and assessed the factors influencing residual MR. Although the ratio of the total MV leaflet area to the MV annulus area was significantly lower in patients with residual MR ≥ 2+ than in those in whom it was < 2+, the ratio of the sum of the leaflets to the mitral AP annulus diameter was comparable between the two groups in their study.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 66%

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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“…Prior studies with early-generation systems demonstrated a reduction in mitral annular dimensions after TEER in patients with functional MR [ 5 , 12 , 13 ]. Additionally, other investigations have demonstrated a significant association between the reduction in the anteroposterior diameter [ 14 ] and the ratio between the total leaflet area and total annular area [ 15 ] with residual MR. To the best of our knowledge, this is the first study to compare, from a comprehensive 3D anatomic standpoint, the differences that take place during TEER between the current and prior-generation systems. The fact that the anteroposterior diameter and annular perimeters and areas were more significantly decreased with the G4 systems might be linked to the greater grasping of leaflets’ tissue due to the longer and wider arms available.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Changes after Transcatheter Edge-to-Edge Repair in Functional MR According to MitraClip Generation

Alperi

Avanzas

Martínez

et al. 2023

JCM

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Background: The use of mitral transcatheter edge-to-edge repair (TEER) is rapidly increasing. Anatomical changes have been described after TEER with the MitraClip system in patients with functional mitral regurgitation (MR), although no study has yet evaluated such anatomical impacts in patients treated with the G4 MitraClip generation. Methods: This research constituted a prospective, single-center, observational study including consecutive patients with functional MR. Mitral three-dimensional images were obtained transesophageally with echocardiography before and immediately after TEER. Patients receiving the late-generation (G4) system were compared to those receiving early-generation systems. Results: A total of 116 functional MR patients were evaluated, and 40 (34.5%) and 76 (65.5%) received a late-generation (G4) or early-generation device system, respectively. The baseline clinical and echocardiographic features were well-balanced between the groups. Overall, there was a significant reduction in mitral annular size after the intervention, and greater reductions in the anteroposterior diameter (4 mm vs. 3.54 mm, p = 0.03), annular perimeter (11.07 mm vs. 5.29 mm for 3D-perimeter, p = 0.001), and annular area (1.29 cm2 vs. 1.03 cm2, p = 0.002) were found for patients receiving the late G4 device generation compared to the early-generation systems. Conclusions: In patients with functional MR, we observed significant changes in mitral valve anatomy with a reduction in anteroposterior diameter, valve perimeter, and area. In our cohort, the extent of those changes was greater with the use of the new-generation G4 MitraClip system compared to prior device generations.

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“…In contrast, secondary MR is defined as MR due to LV and/or LA dysfunction without abnormalities in the MV leaflet and chordae tendineae (11). Although severe secondary MR is associated with adverse prognosis (12)(13)(14), the optimal treatment remains controversial. A recently published COAPT trial showed an incremental benefit of MitraClip implantation in addition to guideline-directed medical therapy in patients with symptomatic severe secondary MR at high surgical risk.…”

Section: Pre-procedural Evaluation Of Mitral Regurgitationmentioning

confidence: 99%

Role of 3D Transesophageal Echocardiography for Transcatheter Mitral Valve Repair—A Mini Review

Hirasawa

Izumo

2022

Front. Cardiovasc. Med.

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Edge-to-edge transcatheter mitral valve repair (TMVr) using MitraClip has been evolving rapidly in patients with severe mitral regurgitation (MR) at high surgical risk or having contraindications for surgery. Three-dimensional (3D) echocardiography plays an important role in the management of severe MR. In particular, 3D transesophageal echocardiography (TEE) imaging allows the evaluation of MV geometry and quantification of MR severity with dedicated software. Real-time 3D TEE is also commonly used to guide TMVr and facilitate the procedure. Further development of 3D echocardiography may help achieve safer and more beneficial results. The following article summarizes the current knowledge and the future perspectives of 3D TEE in TMVr.

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Insufficient Mitral Leaflet Remodeling in Relation to Annular Dilation and Risk of Residual Mitral Regurgitation After MitraClip Implantation

Cited by 15 publications

References 35 publications

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

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

Anatomical Changes after Transcatheter Edge-to-Edge Repair in Functional MR According to MitraClip Generation

Role of 3D Transesophageal Echocardiography for Transcatheter Mitral Valve Repair—A Mini Review

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