Background: The current data on the impact of the increased mitral gradient (MG) on outcomes are ambiguous, and intraprocedural assessment of MG can be challenging. Therefore, we aimed to evaluate (a) peri-interventional dynamics of MG, (b) the impact of intraprocedural MG on clinical outcomes, and (c) predictors for unfavorable MG values after MitraClip.
Methods: We prospectively included patients who underwent MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after 6 months. 12-month survival was documented.
Results: One hundred and seventy five patients (age 81.2 ± 8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups according to intraprocedural MG with a threshold of 4.5 mm Hg, determined by a multivariate analysis of predictors for 12-month mortality (<4.5 mm Hg: Group 1, ≥4.5 mm Hg: Group 2). Intraprocedural MG ≥4.5 mm Hg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, P = .03, OR: 1.70, P = .05), and >3.9 mm Hg was associated with adverse functional outcomes (OR: 1.96, P = .04). The baseline leaflet-to-annulus index >1.1 was found to be the strongest independent predictor (OR: 9.74, P = .001) for unfavorable intraprocedural MG, followed by the number of implanted clips (P = .01), MG at baseline (P = .02), and central clip implantation (P = .05).
Conclusion: An intraprocedural MG <3.9 mm Hg appears to be the best strategy for 1-year survival and favorable functional outcomes after edge-to-edge MV repair with MitraClip independently from MR etiology. Peri-interventional echocardiographic and procedural parameters are useful for the adequate assessment of intraprocedural MG.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/echo.15126 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Transapical beating heart septal myectomy learning curve and training of future surgeons: an observational study.
Int J Surg
December 2024
Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Background: Description of the learning curve for transapical beating heart septal myectomy (TA-BSM) helps to understand the potential for wider adaptability. The authors elaborate and examine a competency-based training assessment for TA-BSM that could serve to disseminate septal myectomy expertise.
Materials And Methods: Data on 177 consecutive patients who underwent the TA-BSM for hypertrophic obstructive cardiomyopathy (HOCM) between April 2022 and June 2023 was collected prospectively, which was registered on ClinicalTrials.
New Technique of Commissural Reconstruction: "Ship Technique" in Rheumatic Mitral Repairs.
Ann Thorac Surg Short Rep
September 2024
Department of Medicine, BronxCare Health System, Bronx, New York.
The commissures are the supporting unit for the leaflets, and they play a vital role in the diastolic and systolic functioning of the mitral valve. This report describes the "ship technique" of commissural reconstruction in rheumatic mitral stenosis repairs. The technique overcomes gradients that are often encountered with limited commissurotomy and residual leaks observed with extended commissurotomy.
View Article and Find Full Text PDFPulmonary hypertension in infancy: a reversible cause.
BMJ Case Rep
January 2025
Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
A term, healthy infant presented with respiratory distress and severe pulmonary hypertension (PH). With an unclear aetiology and the intent to decrease right ventricular afterload, pulmonary vasodilators were initiated. Follow-up imaging revealed a supravalvular mitral ring as the cause of the PH which resolved after surgical resection of the membrane.
View Article and Find Full Text PDFTranscatheter mitral valve implantation in severe mitral annular calcification: a case report.
Eur Heart J Case Rep
January 2025
HerzZentrum Hirslanden, 8032 Zurich, Switzerland.
Background: Mitral annular calcification (MAC) is characterized by severe calcification of mitral annulus and might be associated with both mitral regurgitation and stenosis. It is technically challenging for both surgical and percutaneous approach and is burdened by high mortality.
Case Summary: The present case report describes a complex case of mitral steno-insufficiency (baseline transvalvular gradient = 5 mmHg, effective regurgitant orifice area 0.
Early Patient Outcome and Left Ventricular Function After Mitral Valve Replacement Using a Tilting Disc Mechanical Valve With Total Preservation of Mitral Valvular Apparatus.
Cureus
November 2024
Internal Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, IND.
Introduction The study aimed to retrospectively evaluate the early patient outcome and left ventricular function after mitral valve replacement with a tilting disc valve and total preservation. Patients and methods This retrospective observational study includes patients who underwent mitral valve replacement using a tilting disc valve with total preservation of mitral valvular and subvalvular apparatus from July 2021 to August 2022 at a single center. Results The data were reviewed retrospectively for age, sex, comorbidities, operating time, aortic cross-clamp time, cardiopulmonary bypass time, preoperative and postoperative left ventricular ejection fraction, mean gradient across the mitral valve, left ventricular diameter, left atrial size, atrial fibrillation, complications, mortality, and early patient outcome.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!