Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9 |
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Achieving optimal results in edge-to-edge Transcatheter Mitral Valve repair (TMVr) – Is indirect annuloplasty the key step? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
M. Paukovitsch1, M. Jandek1, W. Rottbauer1, L. Schneider1, S. Markovic1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm; | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Background: Transcatheter Mitral Valve repair (TMVr) using edge-to-edge-therapy causes alterations of mitral valve (MV) and mitral annular geometry. In which way such alterations influence the procedural result is till to explore. Objectives: To create a better understanding of changes in MV geometry during TMVr. We hypothesized that results of edge-to-edge TMVr measured as residual mitral regurgitation (MR) largely depend on specific changes of MV geometry. Methods: We analyzed 106 consecutive patients (October 2019-May 2021) undergoing first time TMVr with implantation of a single device. Intraprocedural transesophageal echocardiography (TEE) data was used to determine changes in MV geometry before and after device implantation. Measurements were performed using a commercially available MV assessment tool (TOMTEC, Munich). Preprocedural und postprocedural measurements of patients with optimal (residual MR ≤1) and non-optimal results (residual MR >1) were compared. Results: There were no differences regarding baseline patient characteristics such as age (80 {IQR:75-84} vs. 77 years {IQR: 65.5-84.5}; p=0.19), gender (male 40% vs. 57.1%, p=0.16) and EuroScoreII (4.3 {IQR: 2.6-6.6} vs. 3.0 {IQR:1.4-6.4}; p=0.15) between patients with optimal and non-optimal results. Functional MR (FMR) was the dominating etiology in our cohort (62.4% vs. 71.4%, p=0.44). Left-ventricular function (LVEF 40.3% vs. 42.7%; p=0.78) and preprocedural mean grade of MR (3.7±0.5 vs. 3.8±0.4; p=0.18) were similar in both groups. In MV assessment showed both preprocedural and postprocedural anterior-posterior (A-P) and anterolateral-posteromedial (AL-PM) diameters as well as annulus circumference (AC) to be significantly larger in patients with non-optimal results. Similarly, the size of the c-shaped annulus and the intertrigonal distance were determined to be larger in patients with a non-optimal result (see table below). A significant reduction of A-P and AL-PM diameters was achieved in all patients. Contrarily, in patients with non-optimal results neither a reduction in annulus circumference nor annulus area was observed. The postprocedural non-planar angle was significantly smaller in patients with an optimal result. Conclusion: Indirect annuloplasty appears to be crucial to achieve optimal results in edge-to-edge TMVr, especially in patients with larger annulus diameters and FMR.
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https://dgk.org/kongress_programme/ht2021/P512.htm |