title: Intraprocedural assessment of mitral regurgitation during the mitraclip procedure: Impact of continuous left atrial pressure monitoring.
abstract: BACKGROUND
  Intraprocedural assessment of mitral regurgitation (MR) is a challenging issue during the MitraClip procedure, which might influence not only the position but also the number of MitraClips implanted. Though transesophageal echocardiography (TEE) is the predominant tool used during the MitraClip procedure, MR assessment might be facilitated by a multimodality approach including continuous and simultaneous determination of left atrial and left ventricular (LV) pressure.
  
  
  METHODS
  86 consecutive patients (76.5 ± 8 years) who qualified for the MitraClip procedure were included into the study. In all patients, the multimodal assessment of MR (TEE, LV angiogram, TEE bubble evaluation, left atrial (LA) pressure => MitraScore) was performed after introducing the MitraClip guide catheter. In the first 42 patients (group A, no CAP), left atrial (LA) pressure (peak pressure of V-wave) was determined only before and after MitraClip implantation, whereas, in the subsequent 44 patients (group B, with CAP), continuous left atrial pressure monitoring (CAP) was performed.
  
  
  RESULTS
  Patients with CAP (group B) had similar total procedural durations and no increase in the complication rate. MitraScore decreased from 10.5 to 3.5 in group A compared to 10.7 to *2.8 in group B (*P = 0.021 vs. group B). Whether the significant improvement of intraprocedural MR in group B translated into superior MR reduction in the conscious patient, was analyzed by transthoracic echocardiography (TTE) in a blinded fashion. Again MR reduction was significantly greater (P = 0.03) in group B (MR grade 2.8 to 0.9) as compared to group A (MR grade 2.8 to 1.3) and 2D vena contracta decreased from 0.54 ± 0.15 cm to 0.17 ± 0.10 in group B compared to group A (0.56 ± 0.19 cm to *0.23 ± 0.12; *P = 0.01 vs. group B).
  
  
  CONCLUSIONS
  Multimodality assessment of intraprocedural MR supported by continuous left atrial pressure monitoring was associated with superior intraprocedural results translating into improved MR reduction also at the end of the hospital stay. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, Heart Center Siegburg, Helios Klinikum Siegburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Horstkotte
authors.affiliation: Department of Cardiology, Heart Center Siegburg, Helios Klinikum Siegburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kloeser
authors.affiliation: Department of Cardiology, Heart Center Siegburg, Helios Klinikum Siegburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Beucher
authors.affiliation: Department of Cardiology, Heart Center Siegburg, Helios Klinikum Siegburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Schwarzlaender
authors.affiliation: 2nd Medical Department, Center for Cardiology, University Hospital Mainz, Mainz, Germany.
authors.forename: R S
authors.initials: RS
authors.lastname: von Bardeleben
authors.affiliation: Department of Cardiology, Heart Center Siegburg, Helios Klinikum Siegburg, Germany.|University of Witten/Herdecke, Witten/Herdecke, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Boekstegers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016279:Atrial Function, Left; D062185:Atrial Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008991:Monitoring, Physiologic / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: MitraScore; hemodynamic changes during MitraClip; percutaneous mitral valve repair