Relative Impact of Surgical Mitral Repair and MitraClip on Annular Remodeling-A Potential Mechanism for Therapeutic Response to Mitral Repair for Degenerative Mitral Regurgitation.
MitraClip
annular remodeling
cardiac surgery
mitral valve repair
percutaneous mitral repair
Journal
Journal of cardiothoracic and vascular anesthesia
ISSN: 1532-8422
Titre abrégé: J Cardiothorac Vasc Anesth
Pays: United States
ID NLM: 9110208
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
12
07
2021
revised:
23
08
2021
accepted:
03
09
2021
pubmed:
4
10
2021
medline:
21
4
2022
entrez:
3
10
2021
Statut:
ppublish
Résumé
Three-dimensional transesophageal echocardiography (TEE) is widely used to guide decision-making for mitral repair. The relative impact of surgical mitral valve repair (MVr) and MitraClip on annular remodeling is unknown. The aim was to determine the impact of both mitral repair strategies on annular geometry, including the primary outcome of annular circumference and area. This was a retrospective observational study of patients who underwent mitral intervention between 2016 and 2020. Weill Cornell Medicine, a single, large, academic medical center. The population comprised 50 patients with degenerative mitral regurgitation (MR) undergoing MVr. Elective MVr and TEE. Patients undergoing MitraClip or surgical MVr were matched (1:1) for sex and coronary artery disease. Mitral annular geometry indices were quantified on intraprocedural three-dimensional TEE. Mild or less MR on follow-up transthoracic echocardiography defined optimal response. Patients undergoing MitraClip were older (80 ± eight v 66 ± six years; p < 0.001) but were otherwise similar to surgical patients. Patients undergoing MitraClip had larger baseline left atrial and ventricular sizes, increased tenting height, and volume (p < 0.01), with a trend toward increased annular area (p = 0.23). MitraClip and surgery both induced immediate mitral annular remodeling, including decreased area, circumference, and tenting height (p < 0.001), with greater remodeling with surgical repair. At follow-up (4.1 ± 9.0 months) optimal response (≤ mild MR) was ∼twofold more common with surgery than MitraClip (81% v 46%; p = 0.02). The relative reduction in annular circumference (odds ratio [OR] 1.05 [1.00-1.09] per cm; p = 0.04) and area (OR 1.03 [1.00-1.05] per cm Surgical MVr and MitraClip both reduce annular size, but repair-induced remodeling is greater with surgery and associated with an increased likelihood of optimal response.
Identifiants
pubmed: 34600832
pii: S1053-0770(21)00800-4
doi: 10.1053/j.jvca.2021.09.006
pmc: PMC9027699
mid: NIHMS1744607
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1279-1287Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL153836
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest None.
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