P981Reverse left ventricular remodeling following percutaneous mitral valve repair with the mitraclip system


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Abstract

Purpose: We assessed left ventricular (LV) remodeling following percutaneous mitral valve repair with the MitraClip System in a cohort of high surgical risk patients with severe mitral regurgitation (MR).Methods: We performed serial 2-D echocardiographic measurements at baseline and after 6 months from the procedure in 38 consecutive patients who underwent percutaneous MV repair. Echocardiographic parameters were recorded to assess presence and extent of LV remodeling and changes in MR. The analyzed parameters included MR grade, LV ejection fraction (EF), LV volumes, LV sphericity index (SI), left atrial area and volume.Results: From October 2008 through June 2010, thirty-eight patients (mean age 72±12 years, male 76%) with MR ≥ 3+ were treated at our Institute with the Mitraclip System. Functional mitral valve disease was the underlying etiology in twenty-three patients (60.5%) while fifteen patients (39.5%) presented with organic degenerative disease. The MitraClip System was successfully implanted in all patients, with a significant reduction in MR (≤ 2 +); 27 patients (71%) were treated with one clip, an additional clip was implanted in 11 patients (29%). A significant improvement in symptoms and NYHA functional class was reported in the majority of treated patients. Echocardiographic evaluation at 6 months showed a significant MR reduction (mean MR grade 3.6 ± 0.5 pre procedure to 1.53 ± 0.5 post procedure, p<0.001). LV indices showed consistent improvement with reduction in LV volumes (indexed LV end-diastolic volume 85.12 ± 33.0 ml/m2 pre procedure to 66.75 ± 25.1 ml/m2 post procedure, p <0.001; indexed LV end-systolic volume 51.8 ± 33.4 ml/m2 pre procedure to 37.51 ± 22.8 ml/m2 post procedure, p< 0.001), a positive change in LV shape with reduction in SI (0.57 ± 0.08 to 0.53 ± 0.05, p <0.001) and a better LV pump function at follow-up, witnessed by an improvement in LVEF (43.4 ± 15.1 % vs. 47.4 ± 12.5 %, p= 0.003). A reduction in left atrial dimensions was also reported (indexed left atrial volume 53.16 ± 17.4 ml/m2 pre procedure to 47.46 ± 15.9 ml/m2 post procedure, p = 0.125). Conclusion: Our initial results with the MitraClip System in a small number of patients indicate that a sustained reduction in MR, following the percutaneous edge-to-edge mitral valve repair, resulted in significant reverse LV remodeling, with reduction in left atrial dimensions.

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