Abstract 10591: Changes in Mitral Annular Geometry Following Percutaneous Edge-to-Edge Mitral Valve Repair Using the Mitraclip Device - New Insights in a High-Risk Patient Cohort
Background: Percutaneous edge-to-edge mitral valve repair (Mitraclip) is an evolving therapy for patients with symptomatic severe mitral regurgitation (MR). Whether this leads to secondary changes in the mitral annulus is unknown.
Methods: We studied changes in mitral annular geometry before and immediately after Mitraclip implant in a cohort of high-risk patients (n=20) with symptomatic MR (more than or equal to grade 3+). Mitral valve quantification software (MVQ) and 3D transesophageal echocardiography were used to measure the following mitral annular parameters, (1) anterior-posterior diameter (DAP, mm), (2) intercommissural diameter (DAlPm, mm), (3) 3D circumference (C3D, mm), (4) 3D area (A3D, mm2) (5) height (H, mm) and (6) sphericity index (DAP/DAlPm ratio) in both functional and degenerative MR etiology.
Results: Eleven patients (52%) had a 2-grade reduction in MR and 6 patients (29%) 1-grade reduction (p <0.01). Overall, there was a significant reduction in all annular parameters, except height (H), immediately post Mitraclip deployment. Functional MR patients had a greater reduction in DAP and sphericity index compared with degenerative MR patients (DAP: 7.7±3.1 vs. 4.3±3.6 mm, p=0.04) (DAP/DAlPm ratio: 0.15±0.09 vs. 0.07±0.07, p=0.03). All other annular measurements did not differ between the 2 groups. While DAP and sphericity index did not predict adverse outcomes at 6 months, there was a trend towards larger pre-Mitraclip DAP where adverse outcomes occurred.
Conclusions: Mitraclip implant leads to acute changes in mitral annular geometry, in particular, a significant reduction in AP diameter that differs according to MR etiology. The impact of these acute changes on longer-term success rates, durability of MR reduction and adverse events remains largely unknown.
- © 2011 by American Heart Association, Inc.