Clinical InvestigationsEchocardiography and Transcatheter Edge-to-Edge RepairAnatomical and Technical Predictors of Three-Dimensional Mitral Valve Area Reduction After Transcatheter Edge-To-Edge Repair
Section snippets
Study Design and Patient Selection
Since 2017, peri-interventional 3D B-mode and color Doppler data acquisition of the MV has been performed by a dedicated team of interventional echocardiographers. Consecutive patients with symptomatic MR undergoing treatment by TEER with MC (Abbott Vascular, Abbott Park, IL) at a single tertiary center (Bern University Hospital) during the period 2017–19 were considered for this analysis. All patients were deemed clinically and anatomically suitable for TEER with the MC system (NTR or XTR) by
Baseline Clinical and Procedural Characteristics
Between March 2017 and December 2019, 150 patients undergoing TEER with the MC were included in an institutional registry for MV interventions. Among them, 116 patients (77%) fulfilled the inclusion criteria of the present analysis. Baseline characteristics of the study cohort are summarized in Table 1. The median age was 81 (76-85) years, 42% were female, 47% had primary MR, and 94% had moderate to severe MR (grade 3+ or 4+). An XTR clip was implanted as the first device in 50% of the
Discussion
This is the first study to systematically evaluate 3D MVA changes after each individual MC implant in a sizeable population of patients and model technical and anatomical parameters to predict the minimal MVABC needed to prevent clinically significant MS in different clinical scenarios.
The principal findings of this study can be summarized as follows:
- 1.
The final 3D MVA after MC implantation(s) depends not only on the size of the native valve but also on the type and position of the clip(s) used.
- 2.
Conclusion
The minimal native baseline MVA preventing clinically relevant MS after TEER is predicted by the number and location of clip(s), orifices morphology, and device type. Based on these parameters, an algorithm has been derived to optimize patient selection and preprocedural planning. We propose a new refined method for MVA measurement accounting for the multiplanarity of the orifice of native nonstenotic MV.
References (17)
- et al.
Impact of interventional edge-to-edge repair on mitral valve geometry
Int J Cardiol
(2017) - et al.
The EVEREST II Trial: design and rationale for a randomized study of the evalve MitraClip system compared with mitral valve surgery for mitral regurgitation
Am Heart J
(2010) - et al.
Effect of percutaneous edge-to-edge repair on mitral valve area and its association with pulmonary hypertension and outcomes
Am J Cardiol
(2017) - et al.
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
(2015) - et al.
Management of mitral stenosis using 2D and 3D echo-Doppler imaging
JACC Cardiovasc Imaging
(2013) - et al.
Real-time 3D transesophageal echocardiography for the evaluation of rheumatic mitral stenosis
JACC Cardiovasc Imaging
(2011) - et al.
Comprehensive assessment of mitral valve geometry and cardiac remodeling with 3-dimensional echocardiography after percutaneous mitral valve repair
Am J Cardiol
(2018) - et al.
Quantitative three-dimensional echocardiographic correlates of optimal mitral regurgitation reduction during transcatheter mitral valve repair
J Am Soc Echocardiogr
(2019)
Cited by (12)
Long-Term Impact of Small Mitral Valve Orifice Area after Transcatheter Edge-to-Edge Mitral Valve Repair on Clinical Outcome: A Three-Dimensional Echocardiography Study
2024, Journal of the American Society of EchocardiographyEstimating Mitral Valve Area Post–Transcatheter Edge-to-Edge Repair: As Simple as 50-40
2023, JACC: Cardiovascular InterventionsBridging the Gap
2023, JACC: Case ReportsThe effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area
2024, Clinical Research in Cardiology
The first two authors should be considered similar in author order.
Conflicts of Interest: F.P. reports travel expenses from Abbott Vascular, Edwards Lifesciences, and Polares Medical. T.P. has received research grants to the institution from Edwards Lifesciences, Symetis/Boston Scientific, and Biotronik and speaker fees from Boston Scientific and Biotronik. S.W. reports research and educational grants to the institution from Abbott, Amgen, BMS, Bayer, Boston Scientific, Biotronik, Cardinal Health, CardioValve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Johnson & Johnson, Medtronic, Querbet, Polares, Sanofi, Terumo, and Sinomed; serves as an unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, Astra Zeneca, BMS, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Sinomed, V-Wave, and Xeltis but has not received personal payments by pharmaceutical companies or device manufacturers; is a member of the steering/executive committee group of several investigated/initiated trials that receive funding by industry without impact on his personal remuneration; and is an unpaid member of the Pfizer Research Award selection committee in Switzerland. All other authors do not have relationships relevant to the contents of this paper to disclose.