title: Acute haemodynamic changes after percutaneous mitral valve repair: relation to mid-term outcomes.
abstract: BACKGROUND
  Percutaneous mitral valve repair (MVR) using the Evalve MitraClip has been recently introduced as a potential alternative to surgical MVR.
  
  
  OBJECTIVE
  To assess immediate haemodynamic changes after percutaneous MVR using right heart catheterisation. Design Single-centre longitudinal cohort study.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  Fifty consecutive non-surgical patients (age 74±14 years, EuroSCORE 26±14) with moderate to severe (3+) and severe (4+) mitral regurgitation (MR) due to functional (56%), degenerative (30%) or mixed (14%) disease were selected.
  
  
  METHODS
  MitraClip implantation was performed under general anaesthesia with fluoroscopy and echocardiographic guidance. Haemodynamic variables were obtained before and after MVR using standard right heart catheterisation and oximetry.
  
  
  METHODS
  Haemodynamic changes immediately before and after MVR.
  
  
  RESULTS
  Acute procedural success (reduction in MR to grade 2+ or less) was achieved in 46 (92%) patients. Mitral valve clipping reduced mean pulmonary capillary wedge pressure (mPCWP) (from 17±7 to 12±5 mm Hg), PCWP v-wave (from 24±11 to 16±7 mm Hg) and mean pulmonary artery pressure (mPAP) (from 29±12 to 24±6 mm Hg), and increased the cardiac index (CI) (from 3.1±1.0 to 3.9±1.1 l/min/m(2)) (all p<0.05). On Cox univariate regression analysis, mPCWP, PCWP v-wave- and mPAP-changes were associated with death, open-heart surgery for MR and/or hospitalisation for heart failure on follow-up.
  
  
  CONCLUSIONS
  In a heterogeneous population with predominantly functional MR, percutaneous MVR with the Evalve MitraClip system lowers mPCWP, PCWP v-wave and mPAP by 20%, 20% and 8%, respectively, and increases the CI by 32%.
authors: Andreas Gruntzig Laboratories, Cardiovascular Center, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland.
authors: Oliver
authors: O
authors: Gaemperli
authors: Marco
authors: M
authors: Moccetti
authors: Daniel
authors: D
authors: Surder
authors: Patric
authors: P
authors: Biaggi
authors: David
authors: D
authors: Hurlimann
authors: Oliver
authors: O
authors: Kretschmar
authors: Ines
authors: I
authors: Buehler
authors: Dominique
authors: D
authors: Bettex
authors: Christian
authors: C
authors: Felix
authors: Thomas F
authors: TF
authors: Luscher
authors: Volkmar
authors: V
authors: Falk
authors: Jurg
authors: J
authors: Grunenfelder
authors: Roberto
authors: R
authors: Corti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology* / Q000628:therapy*; D013525:Surgical Instruments; D016896:Treatment Outcome