Usefulness of Intraprocedural Pulmonary Venous Flow for Predicting Recurrent Mitral Regurgitation and Clinical Outcomes After Percutaneous Mitral Valve Repair With the MitraClip

Objectives

The aim of this study was to determine the prognostic value of pulmonary venous (PV) flow during MitraClip implantation.

Background

The clinical significance of PV flow information during MitraClip implantation is unknown.

Methods

A total of 300 patients who underwent MitraClip implantation and in whom the measurement of PV flow was completed using intraprocedural transesophageal echocardiography were retrospectively reviewed. The optimal threshold of the ratio of systolic velocity-time integral (Svti) to diastolic velocity-time integral (Dvti) ratio after MitraClip placement for major adverse cardiovascular events (all-cause death, redo MitraClip implantation, mitral valve surgery, and heart transplantation) during 12 months was assessed. The best cutoff ratio was 0.72. Patients were divided into 2 groups using this cutoff ratio (low Svti/Dvti, n = 91; high Svti/Dvti, n = 209).

Results

Following mitral regurgitation reduction by MitraClip placement, Svti increased in the both groups. The frequency of mitral regurgitation 3/4+ immediately after MitraClip implantation, at 1-month follow-up, and at 12-month follow-up was significantly higher in patients with low Svti/Dvti ratios than in those with high Svti/Dvti ratios (after MitraClip placement, 5.5% vs. 0%; p < 0.001; at 1 month; 26% vs. 5.2%; p < 0.001; at 12 months, 18% vs. 5.3%; p = 0.006). Major adverse cardiovascular events during 12 months were significantly higher in patients with low Svti/Dvti ratios than in those with high Svti/Dvti ratios (23% vs. 6.2%; p < 0.001). Multivariate analysis demonstrated that low Svti/Dvti ratio was significantly associated with major adverse cardiovascular events during 12 months after adjustment for age, baseline renal function, and mean transmitral pressure gradient (adjusted hazard ratio: 4.00; 95% confidence interval: 2.02 to 8.23; p < 0.001).

Conclusions

PV flow information in the catheterization laboratory immediately after MitraClip implantation predicted recurrent mitral regurgitation and worse long-term outcomes.