Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Immediate hemodynamic changes of transcatheter mitral valve repair in patients with functional and degenerative mitral regurgitation
R. De Rosa1, J. Oppermann1, J. Honold1, U. Fischer-Rasokat2, S. Fichtlscherer3, K. Hemmann1, M. Vasa-Nicotera1, M. Arsalan4, T. Walther4, C. W. Hamm2, A. M. Zeiher1, C. Walther1
1Med. Klinik III - Kardiologie Zentrum der Inneren Medizin- Schwerpunkt Kardiologie, Universitätsklinikum Frankfurt, Frankfurt am Main; 2Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 3Klinik für Kardiologie und Angiologie, Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH, Rotenburg an der Fulda; 4Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main;

Background: Transcatheter mitral valve repair (TMVR) is increasingly performed in patients with severe symptomatic mitral regurgitation (MR) deemed at prohibitive surgical risk. Limited data currently exist regarding the acute impact of TMVR on patients’ hemodynamic status.

Objective: We aimed to investigate the acute hemodynamic effects of successful mitral valve repair in patients at high surgical risk undergoing TMVR with underlying functional MR (FMR) or degenerative MR (DMR).

Methods and results. 115 consecutive patients (mean age: 78.1±7.6 years) receiving TMVR at two different centres were enrolled in this study. All pts were in New York Heart Association (NYHA) Functional Class III or IV. The aetiology of MR was functional in 57 (49.6%) and degenerative in 58 (50.4%) patients. TMVR was performed according to the standard protocol with patients under general anaesthesia and under fluoroscopic and transesophageal echocardiography guidance. Hemodynamic measures were performed including right heart cardiac catheterization before and after TMVR. Successful implantation of the device (Mitraclip in 48 patients, PASCAL in 3 patients) was achieved in all patients. MR grade was reduced from 2.9±0.2 to 1.5±0.5 (p<0.001) in FMR pts and from 3.0±0.2 to 1.3±0.4 (p<0.001) in DMR pts, respectively. Acute postprocedural MR grade ≤2 was achieved in 100% of patients. In pts with FMR, TMVR was associated with immediate increase in cardiac output (CO-from 5.3±1.8 to 7.1±2.5 l/min, p<0.001) and cardiac index (CI-from 2.7±0.9 l/min/m2 to 3.7±1.2 l/min/m2 , p<0.001), with a significant decrease in systemic vascular resistance (SVR-from 1057.3±617.8 to 713.6±435.1, p=<0.001); in patients with DMR, a similar trend was observed, however without reaching a statistical significance (see attached table). Moreover, a relevant decrease in mean LA pressure (FMR: from 18.2±7.5 to 13.1±6.8 mmHg, p<0.001; DMR: from 16.0±7.3 to 11.5±6.7 mmHg, p<0.001) was observed in both groups, whereas there was a significant reduction of mean RA pressure only

   Functional MR  Degenerative MR
   Pre-intervention  Post-intervention  p  Pre-intervention  Post-intervention  p
 MR grade  2.9±0.2  1.5±0.5  <0.001  3.0±0.2  1.3±0.4  <0.001
 SAP  104.2±15.5  100.8±14.9  0.568  107.1±18.0  105.1±12.7  0.647
 DAP  47.0±5.4  45.6±6.5  0.340  53.7±13.2  54.2±10.1  0.828
 MAP  65.7±5.7  65.3±5.8  0.845  71.5±15.4  73.1±11.5  0.602
 Mean RA  9.3±5.1  7.7±5.0  0.032  8.8±5.2  8.1±4.3  0.192
 Ventr PCWP  27.1±16.8  19.9±10.9  0.003  24.7±14.4  17.0±8.8  <0.001
 Mean PCWP  18.5±9.8  14.8±7.9  0.004  16.2±8.8  13.8±5.7  0.009
 Mean PAP  27.8±11.4  25.2±7.5  0.111  26.1±9.6  25.2±7.8  0.339
 Mean LAP  18.2±7.5  13.1±6.8  <0.001  16.0±7.3  11.5±6.7  <0.001
 CO  5.3±1.8  7.1±2.5  <0.001  6.0±3.7  6.8±2.6  0.060
 CI  2.7±0.9  3.7±1.2  <0.001  3.3±2.1  3.7±1.4  0.079
 SVR  1057.3±617.8  713.6±435.1  <0.001  1132.1±407.2  965.2±462.9  0.069
 PVR  168.8±143.9  222.2±483.8  0.415  192.9±157.4  294.4±371.0  0.262
 LA V wave  33.5±16.5  21.1±11.8  <0.001  28.5±14.8  17.9±11.4  <0.001

in FMR pts (from 9.3±5.1 to 7.7±5.0 mmHg, p=0.032). Neither acute changes in mean pulmonary arterial pressures nor in pulmonic vascular resistance were diagnosed in any of the groups.

Conclusions. Successful TMVR using the edge to edge technique results in immediate statistically significant improvement of cardiac output and a relevant decrease of systemic vascular resistance and both atrial pressures in patients with FMR but not in those with DMR. The prognostic relevance has to be determined in further analyses.
https://dgk.org/kongress_programme/jt2021/aP1192.html