Author + information
- Received March 12, 2018
- Revision received June 22, 2018
- Accepted July 13, 2018
- Published online September 12, 2018.
- Frank E. Corrigan III, MDa,b,
- John H. Chen, MDa,
- Aneel Maini, BAa,
- John C. Lisko, MDa,
- Lucia Alvarez, MDa,
- Norihiko Kamioka, MDa,
- Shawn Reginauld, BSa,
- Patrick T. Gleason, MDa,
- Jose F. Condado, MD, MSa,
- Jane Wenjing Wei, MPHc,
- Jose N. Binongo, MPHc,
- Patricia Keegan, DNPa,
- Sharon Howell, RDCSa,
- Vinod H. Thourani, MDd,
- Peter C. Block, MDa,
- Stephen D. Clements, MDa,
- Vasilis C. Babaliaros, MDa and
- Stamatios Lerakis, MDe,∗ ()
- aDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- bDivision of Cardiovascular Medicine, Wellstar Medical Group, Marietta, Georgia
- cDepartment of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- dDepartment of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
- eDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Stamatios Lerakis, Icahn School of Medicine at Mount Sinai, Division of Cardiology, 1 Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives In this study, the authors hypothesized that intraprocedural improvement of pulmonary venous (PV) waveforms are predictive of improved outcomes. In this report, they analyzed intraprocedural invasive and echocardiographic changes with respect to rehospitalization and mortality.
Background The effects of hemodynamic changes during percutaneous mitral valve repair (PMVR) with MitraClip (Abbott Vascular, Santa Clara, California) are incompletely characterized.
Methods The authors retrospectively reviewed records and intraprocedural transesophageal echocardiograms of 115 consecutive patients (age 76 ± 12 years) who underwent PMVR for mitral regurgitation (MR) from May 2013 to January 2017 at Emory University Hospital. They assessed intraprocedural PV waveforms for improvement in morphology, measured change in MR grade by semiquantitative methods, evaluated invasive changes in left atrial pressure (LAP) and V-wave, and compared with 30-day and 1-year rehospitalization and all-cause mortality.
Results Ninety-three cases (80%) had PV waveforms before and after clip placement sufficient for analysis, of which 67 (73%) demonstrated intraprocedural improvement in PV morphology and 25 (27%) did not. At 24 months, 57 (85%) of those with PV improvement were living, compared with only 10 (40%) of those without improvement. Proportional hazards models demonstrated a significant survival advantage in those with PV improvement (hazard ratio [HR] = 0.28, 95% confidence interval [CI] 0.08 to 0.93, p = 0.038). By multivariable analysis, PV improvement predicted reduced 1-year cardiac rehospitalization (odds ratio [OR] = 0.18, p = 0.044). Intraprocedural assessment of MR grade and invasive hemodynamics did not consistently predict mortality and rehospitalization.
Conclusions PV waveforms are important markers of procedural success after PMVR. Our data show intraprocedural PV waveforms may predict rehospitalization and mortality after PMVR. A larger, multicenter cohort will be important to clarify this relationship.
- interventional echocardiography
- percutaneous mitral valve repair
- pulmonary venous waveforms
- structural heart intervention
Ms. Howell has served as a consultant for Abbott Vascular. Dr. Thourani has served as a consultant for Edwards Lifesciences, Sorin Medical, St. Jude Medical, and DirectFlow. Dr. Babaliaros has served as a consultant and investigator for Edwards Lifesciences and Abbott Vascular. Dr. Lerakis has served as a consultant for Edwards Lifesciences and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 12, 2018.
- Revision received June 22, 2018.
- Accepted July 13, 2018.
- 2018 American College of Cardiology Foundation
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