SPC365

Clinical and echocardiographic predictors of worsening mitral regurgitation after percutaneous mitral valve repair

Session: Posters (Sessão 1 - Écran 8) - Doença Valvular 1 - Vários
Speaker: Catarina Oliveira

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Catarina Simões de Oliveira; Pedro Silvério António; Sara Couto Pereira; Pedro Alves da Silva; Joana Brito; Beatriz Valente Silva; Ana Margarida Martins; Ana Beatriz Garcia; Catarina Gregório; João Santos Fonseca; Miguel Nobre Menezes; Cláudia Jorge; João Silva Marques; Fausto j. Pinto; Pedro Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Percutaneous mitral valve repair is an option for patients (pts) with severe mitral regurgitation (MR) that are not good surgical candidates. Since mitral edge-to-edge repair improves MR severity, pts usually report symptomatic and functional improvement. However, there is a trend towards worsening MR overtime after repair.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Evaluate predictors of recurrence and worsening MR after percutaneous mitral valve repair in a real-world population.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single-center record registry of consecutive pts submitted to percutaneous MR repair with MitraClip</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong> </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">from 2013 to October 2021. Demographic, clinical and echo variables were obtained before and after the procedure and during follow up (FUP).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Sixty three procedures were included (mean age 73.5&plusmn;12 years, 60.3% males). Most pts had secondary grade 3 and 4 MR (38 pts, 60.3%), predominantly with Carpentier type 3b MR (33, 52.4%); 35 pts were in NYHA class III and 14 in class IV. At baseline TTE, mean left ventricular ejection fraction was 40.5&plusmn;17%, LV end diastolic volume 147&plusmn;107mL, LV end systolic volume 96&plusmn;88mL, mean vena contracta 7.3&plusmn;1.7 mm, mean regurgitant volume 75&plusmn;37 mL, mean EROA 0.67&plusmn;1.3 cm</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">, LV global longitudinal strain -10.4&plusmn;-4%, RV 4 chambers (C) strain -15.2&plusmn;-6.5, RV free wall (FW) strain -16.2&plusmn;7, TAPSE 19.4&plusmn;10 mm and PSAP 50.5&plusmn;17.4 mmHg.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Procedure success was achieved in 95.2%, with a complication rate of 6.3% (4 pts: procedure failure in 2; 1 vascular complication and 1 stroke). During FUP, 19 pts died (8 from cardiovascular causes). Success of the procedure with acute improvement of MR occurred in 59 pts (&ge;2 grades to no regurgitation or mild in 36 pts). After a mean FUP of 13&plusmn;14.7 months, 32 pts had TTE to evaluate MR: 12 did not worsen MR, 15 worsened MR by 1 point and 5 pts by&nbsp; 2 points. We observed significant improvement of NYHA class in the short term (3.0&plusmn;0.7 vs 2&plusmn;0.7, p=0.001). After a mean FUP of 34.6&plusmn;25.3 months pts maintained symptomatic improvement (2&plusmn;0.7 vs 1.9&plusmn;0.5, p=0.366). Lower baseline RV strain (4C and FW) and TAPSE were predictors of MR worsening to the same grade before the procedure (p=0.011, p=0.027, p=0.005 respectively). We didn&rsquo;t find other TTE or clinical predictors of MR worsening in FUP.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">RV function evaluated with strain and TAPSE before MitraClip were the only predictors of worsening MR at long term FUP. However, our data suggest that clinical improvement may be seen, regardless of MR progression after edge-to-edge repair.&nbsp;</span></span></span></p>

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