title: Mitral valve hemodynamic effects of percutaneous edge-to-edge repair with the MitraClip device for mitral regurgitation.
abstract: BACKGROUND
  The Endovascular Valve Edge-to-Edge REpair STudies (EVEREST) are investigating a percutaneous technique for edge-to-edge mitral valve repair with a repositionable clip. The effects on the mitral valve gradient (MVG) and mitral valve area (MVA) are not known.
  
  
  METHODS
  Twenty seven patients with moderate to severe or severe mitral regurgitation (MR) were enrolled. Echocardiography was performed preprocedure, at discharge, and at 1, 6, and 12 months. Mean MVG was measured by Doppler and MVA by planimetry and pressure half-time, and evaluated in a central core laboratory. Pre- and postclip deployment, simultaneous left atrial/pulmonary capillary wedge and left ventricular pressures were obtained in eight patients.
  
  
  RESULTS
  Three patients did not receive a clip, six patients had their clip(s) explanted by 6 months (none for mitral stenosis), and four were repaired with two clips. Results are notable for a slight increase in mean MVG by Doppler postclip deployment (1.79 +/- 0.89 to 3.31 +/- 2.09 mm Hg, P < 0.01) and an expected decrease in MVA by planimetry (6.49 +/- 1.61 to 4.46 +/- 2.14 cm(2), P < 0.001) and by pressure half time (4.35 +/- 0.98 to 3.01 +/- 1.42 cm(2), P < 0.05). There were no significant changes in hemodynamic parameters postclip deployment by direct pressure measurements. There was no change in MVA by planimetry from discharge to 12 months (3.90 +/- 1.90 to 3.79 +/- 1.54 cm(2), P = 0.78).
  
  
  CONCLUSIONS
  Echocardiographic and hemodynamic measurements after percutaneous mitral valve repair with the MitraClip show an expected decrease in mitral valve area with no evidence of clinically significant mitral stenosis either immediately after clip deployment or after 12 months of follow-up.
authors.affiliation: Cardiac Catheterization Laboratories, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. howard.herrmann@uphs.upenn.edu
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: Sameer
authors.initials: S
authors.lastname: Rohatgi
authors.forename: Hal S
authors.initials: HS
authors.lastname: Wasserman
authors.forename: Peter
authors.initials: P
authors.lastname: Block
authors.forename: William
authors.initials: W
authors.lastname: Gray
authors.forename: Andrew
authors.initials: A
authors.lastname: Hamilton
authors.forename: Alan
authors.initials: A
authors.lastname: Zunamon
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kraybill
authors.forename: John
authors.initials: J
authors.lastname: Merlino
authors.forename: Randy
authors.initials: R
authors.lastname: Martin
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rodriguez
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Patrick
authors.initials: P
authors.lastname: Whitlow
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wiegers
authors.forename: Frank E
authors.initials: FE
authors.lastname: Silvestry
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000517:prevention & control; D011669:Pulmonary Wedge Pressure; D013525:Surgical Instruments / Q000009:adverse effects