The acute effects of edge-to-edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation

Abstract

Background: The effects of edge-to-edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation (MR) have not been well characterized. We evaluated acute changes in mitral annular shape and dimensions, and their effect on MR severity, in patients with functional and degenerative MR following MitraClip^® .

Methods: Patients that underwent MitraClip^® between January 2013 and May 2016 at our institution were retrospectively reviewed.

Exclusions: inadequate images, prior mitral valve repair, and rapid atrial fibrillation. Intra-procedure TEE 3D images acquired prior to and after implantation of MitraClip^® were analyzed using software to model the mitral valve apparatus.

Results: Of seventy-eight patients that underwent MitraClip^® procedure, 60 were eligible. Mean age was 78.3 ± 11 years. Severe MR (4+) was present in 37 patients, moderately/severe MR (3+) in 23. All patients achieved MR reduction to ≤2. 3D annular circumference, bicommissural diameter, and anteroposterior diameter had a significant size reduction after MitraClip^® . None of the mitral annular measures had significantly different mean change between the large and small MR change groups at the 0.05 significance level.

Conclusions: In patients with functional or degenerative MR, the MitraClip^® significantly affect mitral annular dimensions; however, these changes do not correlate with the immediate MR reduction.

Keywords: mitral annulus; mitral annulus modeling; mitral regurgitation; mitral valve; percutaneous mitral valve repair; structural heart disease interventions; valvular heart disease.