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Acute haemodynamic changes after percutaneous mitral valve repair: relation to mid-term outcomes
  1. Oliver Gaemperli1,
  2. Marco Moccetti1,2,
  3. Daniel Surder1,2,
  4. Patric Biaggi3,
  5. David Hurlimann3,
  6. Oliver Kretschmar1,
  7. Ines Buehler1,
  8. Dominique Bettex4,
  9. Christian Felix4,
  10. Thomas F Luscher1,
  11. Volkmar Falk5,
  12. Jurg Grunenfelder5,
  13. Roberto Corti1
  1. 1Cardiovascular Center, Andreas Gruntzig Cardiac Catheterization Laboratories, University Hospital Zurich, Zurich, Switzerland
  2. 2Cardiocentro Ticino, Lugano, Switzerland
  3. 3Cardiovascular Center, Echocardiography, Zurich, Switzerland
  4. 4Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
  5. 5Cardiovascular Surgery, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Professor Roberto Corti, Andreas Gruntzig Laboratories, Cardiovascular Center, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland; roberto.corti{at}usz.ch

Abstract

Background Percutaneous mitral valve repair (MVR) using the Evalve MitraClip has been recently introduced as a potential alternative to surgical MVR.

Objective To assess immediate haemodynamic changes after percutaneous MVR using right heart catheterisation.

Design Single-centre longitudinal cohort study.

Setting Tertiary referral centre.

Patients Fifty consecutive non-surgical patients (age 74±14 years, EuroSCORE 26±14) with moderate to severe (3+) and severe (4+) mitral regurgitation (MR) due to functional (56%), degenerative (30%) or mixed (14%) disease were selected.

Interventions MitraClip implantation was performed under general anaesthesia with fluoroscopy and echocardiographic guidance. Haemodynamic variables were obtained before and after MVR using standard right heart catheterisation and oximetry.

Main outcome measures Haemodynamic changes immediately before and after MVR.

Results Acute procedural success (reduction in MR to grade 2+ or less) was achieved in 46 (92%) patients. Mitral valve clipping reduced mean pulmonary capillary wedge pressure (mPCWP) (from 17±7 to 12±5 mm Hg), PCWP v-wave (from 24±11 to 16±7 mm Hg) and mean pulmonary artery pressure (mPAP) (from 29±12 to 24±6 mm Hg), and increased the cardiac index (CI) (from 3.1±1.0 to 3.9±1.1 l/min/m2) (all p<0.05). On Cox univariate regression analysis, mPCWP, PCWP v-wave- and mPAP-changes were associated with death, open-heart surgery for MR and/or hospitalisation for heart failure on follow-up.

Conclusion In a heterogeneous population with predominantly functional MR, percutaneous MVR with the Evalve MitraClip system lowers mPCWP, PCWP v-wave and mPAP by 20%, 20% and 8%, respectively, and increases the CI by 32%.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the institutional review board of the University Hospital Zurich.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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