Clinical Research
Intervention in Valve Disease
The Acute Hemodynamic Effects of MitraClip Therapy

https://doi.org/10.1016/j.jacc.2010.11.043Get rights and content
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Objectives

The objective of this study was to evaluate the acute hemodynamic consequences of mitral valve (MV) repair with the MitraClip device (Abbott Vascular, Menlo Park, California).

Background

Whether surgical correction of mitral regurgitation (MR) results in a low cardiac output (CO) state because of an acute increase in afterload remains controversial. The acute hemodynamic consequences of MR reduction with the MitraClip device have not been studied.

Methods

We evaluated 107 patients with cardiac catheterization before and immediately following percutaneous MV repair with the MitraClip device. In addition, pre- and post-procedural hemodynamic parameters were studied by transthoracic echocardiography.

Results

MitraClip treatment was attempted in 107 patients, and in 96 (90%) patients, a MitraClip was deployed. Successful MitraClip treatment resulted in: 1) an increase in CO from 5.0 ± 2.0 l/min to 5.7 ± 1.9 l/min (p = 0.003); 2) an increase in forward stroke volume (FSV) from 57 ± 17 ml to 65 ± 18 ml (p < 0.001); and 3) a decrease in systemic vascular resistance from 1,226 ± 481 dyn·s/cm5 to 1,004 ± 442 dyn·s/cm5 (p < 0.001). In addition, there was left ventricular (LV) unloading manifested by a decrease in LV end-diastolic pressure from 11.4 ± 9.0 mm Hg to 8.8 ± 5.8 mm Hg (p = 0.016) and a decrease in LV end-diastolic volume from 172 ± 37 ml to 158 ± 38 ml (p < 0.001). None of the patients developed acute post-procedural low CO state.

Conclusions

Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR. (A Study of the Evalve Cardiovascular Valve Repair System Endovascular Valve Edge-to-Edge Repair Study [EVEREST I]; NCT00209339 and EVEREST II; NCT00209274)

Key Words

cardiac output
hemodynamics
MitraClip
mitral regurgitation

Abbreviations and Acronyms

APS
acute procedural success
CI
cardiac index
CO
cardiac output
FSV
forward stroke volume
LA
left atrial/atrium
LV
left ventricular/ventricle
LVEDP
left ventricular end-diastolic pressure
LVEDV
left ventricular end-diastolic volume
LVEF
left ventricular ejection fraction
LVESV
left ventricular end-systolic volume
MR
mitral regurgitation
MV
mitral valve
NYHA
New York Heart Association
PA
pulmonary artery
PASP
pulmonary artery systolic pressure
PCWP
pulmonary capillary wedge pressure
PVR
pulmonary vascular resistance
RA
right atrial/atrium
SVR
systemic vascular resistance
TTE
transthoracic echocardiography

Cited by (0)

Dr. Siegel is a speaker for Philips Ultrasound and a consultant for Abbott. Dr. Rinaldi is on the advisory boards of Abbott, Boston Scientific, and Cordis. Dr. Lim is a consultant to and receives research funding from Abbott Vascular. Dr. Fail is on the medical advisory board for and has stock options in CardioSolutions. Dr. Hermiller is a consultant for Abbott Vascular. Dr. Smalling receives grant support from Evalve. Dr. Whitlow receives research support from Evalve. Dr. Hermann receives research funding from Evalve and Abbott and has equity in and is a consultant to Endovalve. Dr. Foster receives grant support from Evalve, Boston Scientific, EBR Systems, and GDS Systems. Dr. Feldman receives research support and is a consultant to Abbott and Edwards. Dr. Kar receives research grants and honoraria from and is a consultant to Abbott Vascular. All other authors have reported that they have no relationships to disclose. Drs. Siegel and Biner contributed equally to this work.