Mitral valve intervention 981
In the follow-up period 33.3% vs. 13.1% of patients experienced hospitalization
for heart failure (p<0.0001).
Conclusion: MC therapy for FMR is a valuable treatment for high-risk patients.
In patients not suitable for MC implantation because of unfavourable anatomy,
conservative treatment with medical therapy appears as inadequate as these pa-
tients have a higher mortality. Newer and alternative percutaneous mitral valve
therapies are needed in patients with severe symptomatic MR refused for MC
therapy.
P5381 | BEDSIDE
Atrial septal defect with significant r i ght-to-left shunt as a
complication of successful percutaneous mitral valve repair with
the MitraClip
V. Rudolph
1
, M. Huntgeburth
1
, E. Lubos
2
, M. Schlueter
2
, D. Lubs
2
, J. Mueller-
Ehmsen
1
, B. Goldmann
2
, S. Blankenberg
2
, S. Baldus
1
.
1
Cologne University
Hospital - Heart Center, Cologne, Germany;
2
University Heart Center Hamburg,
Hamburg, Germany
Background: Percutaneous mitral valve repair with the MitraClip (PMVR) has
been demonstrated to be feasible and safe and results in significant symptomatic
improvement even in patients at high risk for surgery. Although it is generally
acknowledged that a postinterventional atrial septal defect (ASD) is detectable in
the majority of patients due to the transseptal access as an essential prerequisite
for this procedure, its clinical significance has so far been contested.
Methods and results: Out of 399 consecutive patients treated with the MitraClip
at two clinical sites 5 patients were indicative of a clinically significant right-to-left
shunt requiring periinterventional implantation of an ASD occluder. The mean age
of the 5 patients was 68±7 years. All patients suffered from functional mitral re-
gurgitation due to leaflet tethering as a consequence of left ventricular dilation and
moderate to severe impairment of left ventricular function in four cases and due
to annular dilation in one patient with chronic atrial fibrillation but preserved left
ventricular function. PMVR was successful in all 5 patients, with a reduction in MR
severity to grade 2+ in two patients and grade 1+ in three patients. Two patients
exhibited pulmonary hypertension classified as "out of proportion" Dana Point II
and the remaining three patients had high-grade tricuspid regurgitation without
elevation of mean pulmonary arterial pressure. Right-to-left-shunt became clini-
cally manifest in all patients by a drop in arterial oxygen saturation. In the most
dramatic case oxygen saturation dropped immediately after grasping of the mitral
leaflets while the transseptal guide catheter was still in position. In the most le-
nient case, an oxygen saturation of 86% was noted after extubation under room
air and the patient received an ASD occluder three days after the procedure. Of
the remaining patients, two received an ASD occluder during the PMVR proce-
dure and one patient one day after PMVR. All patients received an Amplatzer
®
septal occluder (12-20 mm). No further complications were encountered due to
ASD occluder implantation; all patients had an uneventful clinical course.
Discussion: Iatrogenic atrial septal defect is a rare but potentially significant
complication in patients undergoing PMVR, particularly in the presence of el-
evated pulmonary arterial pressure or severe tricuspid regurgitation. Screen-
ing for postinterventional ASD should be performed in all patients undergoing
PMVR. Whether inapparent shunting affects the clinical course of patients follow-
ing PMVR deserves thorough future investigation.
P5382 | BENCH
Echocardiographic evaluation of right ventricular function after
MitraClip implantation in functional mitral regurgitation
C. Giannini, V.D.B. Di Bello, M.D.C. De Carlo, F.F. Fiorelli, F.G. Guarracino,
L.C. Conte, A.P. Pieroni, A.S.P. Petronio.
Cardiac Thoracic and Vascular
Department, Pisa, Italy
Aims: Percutaneous mitral valve repair (PMVR) for mitral regurgitation (MR) can
be performed with the MitraClip System. Our aim was to assess the changes of
right ventricular (RV) after Mitraclip in patients with functional MR.
Methods and results: Between November 2009 and December 2012, 44 pa-
tients affected by severe functional MR underwent PMVR with the MitraClip.
Patients who didn’t undergo successful Mitraclip implantation were excluded
from the analysis. Therefore, the study population included 35 patients. Me-
dian age was 75 years (63-81), 65.7% (n=23) were male with a median logis-
tic EuroSCORE of 20%. Patients with MR grade ≥3+ were 5.7% and 11.4%
at discharge and 6 months, respectively (p<0.0001) versus 100% at base-
line, with a clinical benefit in NYHA class (p<0.0001). BNP plasma levels re-
vealed a significant overall decrease at follow-up (from 61.1±16.5 to 32.9±18.4;
P<0.0001). Improvements in left ventricular (LV) size and function were observed.
At baseline, before discharge and 6-months, respectively, the LV end-diastolic
diameter was 66.1±11.2mm, 63.6±10.8mm and 61.6±11.3mm (p<0.0001),
the LV end-diastolic volume 191.4±73.7ml, 174.2±72.3ml and 152.9±73.1ml
(p<0.0001), the LV ejection fraction 36.5±11.3%, 39.2±9.7% and 41.8±10.5%
(p<0.0001). During follow-up, an improvement in the RV function was also ob-
served. At baseline, before discharge and 6-months, respectively, the tricus-
pid annulus plane systolic excursion (TAPSE) was 16.8±3.9mm, 18.7±3.4mm
and 19.3±4.5mm (p=0.001), the systolic pulmonary artery pressure (SPAP):
50.1±6.8mmHg, 41.2±6.8 mmHg and 38.1±6.8 mmHg (p<0.0001), the sys-
tolic velocity at the tricuspid annular (RV-Sm): 8.8±2.9 cm, 10.4±3.5 cm and
117.7±3.1 cm (p<0.0001). Moreover, we observed right atrial (RA) reverse re-
modeling with significant decrease in RA area (p<0.0001). A significant inverse
correlation was observed between baseline NYHA class and TAPSE (r = -0.36,
P = 0.03) while a significant positive correlation was seen between baseline MR
grade and 6-months TAPSE (r = 0.44, P = 0.03). 6-months TAPSE improvement
correlated significantly with improvements in NYHA class (r = -0.41, P = 0.05).
Conclusion: MitraClip implantation has induced a significant reduction of LV vol-
ume overload. The concomitant reduction of LV filling pressure, after Mitraclip
implantation, reflected nearly immediately on clinical profile and on hemodynam-
ics of the right sections. In fact, since discharge, we observed both a significant
reduction of SPAP and a significant increase of longitudinal RV systolic function
as shown by the increase of TAPSE and RV-Sm.
P5383 | BEDSIDE
The acute haemodynamic effect of the MitraClip therapy: afterload
mismatch evaluation in functional mitral regurgitation
G. Melisurgo, S. Ajello, M. Kawaguchi, A. Latib, O. Alfieri, F. Pappalardo,
F. Maisano.
Ospedale San Raffaele, Milano, Italy
Background: Despite the safety and the efficacy of the MitraClip percutaneous
mitral valve repair (MVR) have been assessed in randomized international trials,
limited data on the acute hemodynamic impact are available. Afterload mismatch,
defined as an impairment of left ventricular function after correction of mitral re-
gurgitation (MR), is a known complication after surgery. The aim of this study is to
investigate the incidence and the prognostic role of afterload mismatch in patients
undergoing MitraClip therapy.
Methods ans results: We retrospectively analyzed 76 consecutive patients, af-
fected by functional MR (fMR) and submitted to MitraClip therapy. 3 patients with
post-procedural MR≥3+ were excluded from the analysis. The remaining 73 pa-
tients were assigned to two groups according to the occurrence of the afterload
mismatch. Afterload mismatch was defined as an acute EF reduction of -28% af-
ter MitraClip therapy, compared to the baseline assessment (this value represents
the first quartile in the distribution of the change of the EF; baseline LVEF mean
value 27±9).
Afterload mismatch was observed in 19 pts (26%) in the early postoperative pe-
riod (LVEF 16±7 in group with afterload mismatch (AM+) vs 28±10 in group
without afterload mismatch (AM-); p<0,0001). At univariate analysis preopera-
tive EDD (71 vs 67 mm; P = 0,022) and ESD (57 vs 53 mm; P = 0,042) were
significantly higher in AM+ as compared to AM-. AM+ patients experienced an
increased incidence of right ventricular dysfunction (68% of pts vs 31% of pts;
P= 0,049) and pulmonary hypertension (49 vs 40mmHg; P = 0,0009). No differ-
ence in the use of inotropes (84% of pts vs 83% of pts; P= 0,92), in acute renal
failure (16% vs 28% of pts; P= 0,29) and in length of stay in intensive care unit
(22,4 vs 23,7 hours P= 0,92) was recorded among the two groups. Patients in the
AM+ group showed a significant recovery of LVEF (p<0,0001) before hospital dis-
charge, without any significant differences as compared to the AM- group (31%
vs 33%, p=0,65). Long term survival was comparable between the two groups
(81,2±9,9% vs 75,2±8,7%; P = 0,44).
Conclusion: The reduction of MR by MitraClip therapy can be associated with af-
terload mismatch, especially in patients with preoperative increased left ventric-
ular diastolic and systolic diameters. However afterload mismatch is reversible,
without long-term prognostic implications.
P5384 | BEDSIDE
The role of gender during percutaneous catheter-based treatment
of mitral insufficiency with the MitraClipTM system
R. Zahn
1
, T. Bauer
1
, S. Baldus
2
, W. Schillinger
3
, O. Franzen
4
, R. Bekeredijan
5
,
H. Sievert
6
, J. Schofer
7
,K.Kuck
8
, J. Senges
9
on behalf of TRAMI investigators.
1
Clinical Center of Ludwigshafen, Ludwigshafen am Rhein, Germany;
2
Cologne University Hospital - Heart Center, Clinic III for Internal Medicine,
Cologne, Germany;
3
Heart Research Center Gottingen, Georg-August
University, Department of Cardiology and Pneumology, Gottingen, Germany;
4
Rigshospitalet - Copenhagen University Hospital, Heart Centre, Cardiac
Catheterization Laboratory, Copenhagen, Denmark;
5
University Hospital of
Heidelberg, Department of Cardiology, Heidelberg, Germany;
6
CardioVascular
Center Frankfurt, Sankt Katharinen, Frankfurt am Main, Germany;
7
Medical Care
Center Prof. Mathey, Prof. Schofer, University Cardiovascular Center, Hamburg,
Germany;
8
Asklepios Clinic St. Georg, Department of Cardiology, Hamburg,
Germany;
9
Heart Center of Ludwigshafen, Heart Attack Research Center at the
University of Heidelberg, Ludwigshafen am Rhein, Germany
Background: Catheter-based treatment of mitral insufficiency with the Mitra-
ClipTM – system in non-operable or high surgical risk patients is establishing as
an accepted therapeutic option. The influence of gender on patient characteristics
and clinical results has to be defined yet.
Methods: We analysed data of the German transcatheter mitral valve interven-
tions (TRAMI) - registry.
Results: Until 10/2012 971 patients from 15 centers treated with the MitraClipTM
system were included: 595 (61.3%) men and 376 (38.7%) women. Patient as well
as interventional characteristics and clinical events are given in the table.
Conclusions: In current clinical practice MitraClipTM- implantation is performed
in women in about 1/3 of all cases. Women are 4 years older and recieve less
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