Mitral valve repair using multiple MitraClips®: a dobutamine stress echocardiography evaluation.
OBJECTIVE
The haemodynamic effect of mitral valve (MV) repair using multiple MitraClips® (MC) has not been investigated. The aim of the study was to evaluate the stress performance of MV repair with MC.


RESULTS
Twenty consecutive patients (77±7 years, 13 men [65%]) after implantation of >2 MitraClips® were subsequently evaluated with dobutamine stress echocardiography (DSE). After MC implantation, mean transmitral pressure gradient (TPG) (3.3±0.8 mmHg vs. 4.0±0.6 mmHg; p<0.001) and mitral valve orifice area (2.9±0.3 cm2 vs. 3.9±0.4 cm2; p<0.001) were significantly increased during DSE showing a physiological behaviour effect of the MV. LVEF (41±18% vs. 46±21%; p<0.001) and systolic pulmonary artery pressure (42±11 mmHg vs. 44±12 mmHg; p=0.014) increased significantly. The degree of MR was stable during stress (p=0.68). At linear regression, only baseline peak TPG was related to stress mean TPG (p<0.001; Beta 0.816; 95% CI: 0.368-0.918).


CONCLUSIONS
MV repair using MitraClips® should be performed with the aim of maximal reduction of MR degree. MV repair using MC may not lead to pathological degrees of MV stenosis. Although the TPG is significantly increased during stress, it never reaches pathological levels and is always accompanied by a significant increase in MVOA. The degree of residual MR remains unchanged during maximal pharmacological stress.
Heart Center Rostock, University Hospital Rostock, Rostock, Germany.
Liliya
L
Paranskaya
Giuseppe
G
D'Ancona
Ilkay
I
Bozdag-Turan
Stephan
S
Kische
Ibrahim
I
Akin
Gökmen R
GR
Turan
Jasmin
J
Ortak
Jan
J
Schuetz
Christoph A
CA
Nienaber
Hüseyin
H
Ince
D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D025401:Echocardiography, Stress; D004867:Equipment Design; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D008946:Mitral Valve Stenosis / Q000209:etiology; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D020127:Recovery of Function; D012307:Risk Factors; D013318:Stroke Volume; D013525:Surgical Instruments; D016896:Treatment Outcome; D016277:Ventricular Function, Left