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The effects of MitraClip for severe mitral regurgitation on right ventricular function and remodelling
Session:
Sessão de Posters 54 - Intervenção valvular mitral
Speaker:
Rafaela Fernandes
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Rafaela Fernandes; Diogo Fernandes; Mariana Simões; Gonçalo Terleira Batista; Tatiana Santos; Ana L. Silva; Vanessa Lopes; Eric Monteiro; Joana Guimarães; Gonçalo Costa; Joana Moura Ferreira; Lino Gonçalves
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background: </strong>MitraClip revolutionized the treatment of mitral regurgitation (MR). There is an uncertainty about its capacity to improve right ventricle (RV) function and reverse remodelling. We hypothesized that the reduction of RV afterload after MitraClip could contribute to RV function and reverse remodelling. </span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong>: Single-centre retrospective observational study in patients with MR who underwent MitraClip procedure between November 2018 and September 2023. We aimed to evaluate RV remodelling after MitraClip procedure. Patients had to perform a basal and follow-up transthoracic echocardiography (TTE). RV function was assessed by tricuspid annular plane systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S’). RV reverse remodelling was determined by RV end-diastolic diameter (RVEDD), tricuspid regurgitation maximal velocity (TRV), pulmonary artery systolic pressure (PSAP) and RV-pulmonary artery (RV-PA) coupling (obtained as the ratio between TAPSE and PSAP). Data was collected through a revision of informatized clinical files. Statistical analysis used Kolmogorov-Smirnov test to assess normality, and T Student test or non-parametric equivalent tests for variable analysis. </span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong>: 45 patients were included. Most were male (32/71%), with a significant prevalence of cardiovascular risk factors (obesity=17/29.8%, diabetes=22/36.1%, dyslipidaemia=40/65.6%, hypertension=42/68.9%, smoker=5/16.4%). Median age was 79<span style="font-family:Symbol">±</span>12 years. Majority had severe MR (40/88.9%), and nearly half (26/48.1%) had symptomatic heart failure (HF) classified as III-IV by the New York Heart Association (NYHA). Mean follow-up time was 27.4<span style="font-family:Symbol">±</span>16.4 months. TTE was performed in a mean time of 7.50<span style="font-family:Symbol">±</span>6.68 months after procedure. During follow-up, 5 (11.1%) patients died but only in one case the cause was decompensated HF. An improvement of HF symptoms was observed as most patients achieved a I-II NYHA class (36/90.0%). There were no statistically significant differences in RV function measured by TAPSE or S’. Also, baseline TAPSE <span style="font-family:Symbol">£</span>15mm was not associated with increased mortality. No statistically significant differences were found in RV reverse remodelling assessed by RVEDD, TRV, PSAP or RV-PA coupling. </span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong>: MitraClip is an essential technique for MR, with a strong benefit on clinical outcomes. However, controversy remains of its impact on RV function and possible RV reverse remodeling. </span></span></span></p>
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