SPC365

Impact of transcatheter mitral valve repair on echocardiographic parameters of the right ventricle – a closer look to the forgotten half of the heart

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: João Gameiro

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Posters
FP Number: ---
Authors: João Gameiro; Carolina Saleiro; Diana Campos; José Sousa; Ana Rita Gomes; Luís Puga; Eric Monteiro; Gonçalo Costa; Luís Paiva; Joana Silva; Marco Costa; Lino Gonçalves

<p><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Background</strong></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">Transcatheter mitral valve repair has demonstrated to reduce acute&nbsp;heart failure (HF) hospitalizations, when compared to optimal medical treatment.</span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">Right ventricle (RV) dysfunction has a major effect on the prognosis of patients (P) with HF and mitral regurgitation (MR). In spite of this, the majority of studies assessing RV function in the literature focused on the prognostic role of baseline RV function, with only few reports available regarding RV function during follow-up.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="background-color:white"><span style="color:#4472c4">.</span></span></span><span style="font-family:Arial,Helvetica,sans-serif"><strong>Purpose</strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">The aim of this study is to assess the change in echocardiographic parameters related to the RV following successful mitral valve repair using the MitraClip <span style="background-color:white"><span style="color:#4d5156">&trade;</span></span>.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">A retrospective cohort study from consecutive P submitted to transcatheter mitral valve repair in our centre, between November 2018 and November 2020. </span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">All P underwent echocardiographic assessment (transthoracic and transoesophageal) for evaluation of the severity and etiology of MR, ventricular function and dimensions for conformation of suitability for the MitraClip <span style="background-color:white"><span style="color:#4d5156">&trade;</span></span> procedure. Follow-up with transthoracic echo was performed routinely 3 months after the procedure. All baseline, procedural and follow-up data were collected.&nbsp; </span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">Changes between baseline and follow-up parameters were assessed using the paired t-Test.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">A total of 25 P underwent MitraClip<span style="background-color:white"><span style="color:#4d5156">&trade;</span></span> implantation (87.5% male sex, mean age of 75.7 &plusmn; 8). In this cohort, all P suffered from severe MR (mean effective regurgitant orifice area of 40.4 &plusmn; 9 mm2), 62.5% P with a functional etiology. As comorbidities, 66.7% had atrial fibrillation, 25% had coronary artery disease and 37.5% had chronic renal disease. Mean NT-proBNP level on admission was 2291 ng/L.</span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">On the pre-procedure echocardiography, 29.2% P had reduced ejection fraction of the left ventricle, 66.7% P had pulmonary hypertension (mean pulmonary artery systolic pressure (PASP) of 43.2 &plusmn;11mmHg), 45.8% had RV systolic dysfunction and 33% had RV dilatation (mean basal diameter of 41 &plusmn; 8 mm). </span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">On follow-up, long-term mortality was 8.3%, with hospital readmissions in 25% of P. </span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">After a mean echocardiography follow-up of 3.2 &plusmn; 1.5 months following the MitraClip procedure, in the overall study population, TAPSE increased from 16.9 &plusmn; 4 to 19.2 &plusmn; 5 mm (p = 0.005) and mean basal diameter of the RV reduced from 41 &plusmn; 8 mm to 37&plusmn; 6 mm (p= 0.02). Reduction of PASP from 43.7 &plusmn; 9 to 41.9 &plusmn; 10 mmHg did not reach statistical significance (p = 0.564). </span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusion</strong></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px">The present study demonstrates that the MitraClip can lead to reverse RV remodelling in some P, improving its RV systolic function.</span></span></p>